Full Year Research Articles

Prevalence of covid-19 and long covid in collegiate student athletes from spring 2020 to fall 2021: a retrospective survey

BackgroundSymptomatic COVID-19 and Long COVID, also referred to as post-acute sequelae of SARS-CoV-2 (PASC) or post-COVID conditions, have been widely reported in young, healthy people, but their prevalence has not yet been determined in student athletes. We sought to estimate the prevalence of reported COVID-19, symptomatic COVID-19, and Long COVID in college athletes in the United States attending 18 schools from spring 2020 to fall 2021.MethodsWe developed an online survey to measure the prevalence of student athletes who tested positive for COVID-19, developed Long COVID, and did not return to their sport during the relevant time period. We surveyed a convenience sample of 18 collegiate school administrators, representing about 7,000 student athletes. Of those schools surveyed, 16 responded regarding the spring 2020 semester, and 18 responded regarding the full academic year of fall 2020 to spring 2021 (both semesters).ResultsAccording to the survey responses, there were 9.8% of student athletes who tested positive for COVID-19 in spring 2020 and 25.4% who tested positive in the academic year of fall 2020 to spring 2021. About 4% of student athletes who tested positive from spring 2020 to spring 2021 developed Long COVID, defined as new, recurring, or ongoing physical or mental health consequences occurring 4 or more weeks after SARS-CoV-2 infection.ConclusionsThis study highlights that Long COVID occurs among young, healthy athletes and is a real consequence of COVID-19. Understanding the prevalence of Long COVID in this population requires longer follow-up and further study.

Seasonality of COVID-19 incidence in the United States.

The surges of Coronavirus Disease 2019 (COVID-19) appeared to follow a repeating pattern of COVID-19 outbreaks regardless of social distancing, mask mandates, and vaccination campaigns. This study aimed to investigate the seasonality of COVID-19 incidence in the United States of America (USA), and to delineate the dominant frequencies of the periodic patterns of the disease. We characterized periodicity in COVID-19 incidences over the first three full seasonal years (March 2020 to March 2023) of the COVID-19 pandemic in the USA. We utilized a spectral analysis approach to find the naturally occurring dominant frequencies of oscillation in the incidence data using a Fast Fourier Transform (FFT) algorithm. Our study revealed four dominant peaks in the periodogram: the two most dominant peaks show a period of oscillation of 366 days and 146.4 days, while two smaller peaks indicate periods of 183 days and 122 days. The period of 366 days indicates that there is a single COVID-19 outbreak that occurs approximately once every year, which correlates with the dominant outbreak in the early/mid-winter months. The period of 146.4 days indicates approximately 3 peaks per year and matches well with each of the 3 annual outbreaks per year. Our study revealed the predictable seasonality of COVID-19 outbreaks, which will guide public health preventative efforts to control future outbreaks. However, the methods used in this study cannot predict the amplitudes of the incidences in each outbreak: a multifactorial problem that involves complex environmental, social, and viral strain variables.

Online Balint Groups in Iran during the Covid-19 Pandemic.

When Covid-19 was declared a pandemic, most people felt helpless, fearful, and demoralized while health care workers put their own lives at risk to support and heal others. The uncertainties expressed by experts and the ambiguous and protracted nature of the pandemic compounded the sense of frustration caused by the scarcity of protective equipment and effective medications. This combination of factors led to exhaustion, burnout, and moral injury. As a result, mental health practitioners worldwide realized that health care staff needed to stay motivated and resilient. Our contribution in this regard was to start Balint groups throughout Iran, online, for a full year. We learned some lessons worth sharing. Our insights were wrapped around challenges but proved helpful to preserve the integrity of delivering medical services in times of crisis.

Effect of Benzyl Adenine, Calcium Chloride and Chitosan on Growth and Flower Production of Gerbera Jamesonii Bolus ex. Hook. Cv. Esmara

The experiment was conducted in the field of the Department of Horticulture and Landscaping Desigen, College of Agriculture and Forestry, University of Mosul, during the period from March 2021 to April 2022, on the Gerbera plant Gerbera jamesonii (Esmara), with the aim of studying its response to treatment with benzyl adenine at a concentrations: 0 and 250 mg l-1 and calcium chloride at a concentrations: 0, 125 and 250 mgl-1 and chitosan at a concentrations: 0, 150 and 300 mgl-1, sprayed on the vegetative growth monthly, for a full year, starting from March 2021 until April 2022. It was used in the implementation of the experiment A Factorial Experiment of two Split Plots with a Randomized Complete Block Design with three replications and 15 treatment plants. The results showed that the treatment of plants with benzyl adenine with spraying with calcium chloride at a concentration of 250 mgl-1 for both interact with spraying with chitosan at a concentration of 300 mgl-1 recorded the highest significant values for the characteristics of: total yield of inflorescences produced, number of leaves, leaves area, number of branches and leaf content of total chlorophyll in against the lowest values of the control treatment. The results of the characteristics of the inflorescences produced during the study seasons, including the inflorescence diameter, the scape length, and the inflorescences yield, showed that they were at their maximum during the spring season, while the largest significant values were recorded for the inflorescence diameter and the vase life during the winter season.

AN IN-DEPTH EXPLORATION OF RELIGIOUS TOURISM IN UTTAR PRADESH

Tourism encompasses the activities of individuals or societies who venture beyond their usual surroundings for a duration of less than a full year, primarily for leisure, business, or other non-migration-related purposes. When discussing religious tourism, Uttar Pradesh emerges as a renowned Indian state celebrated for its rich religious and cultural heritage, owing to the presence of sacred rivers like the Ganga, Yamuna, and Saraswati, alongside various revered religious sites such as Varanasi, Vrindavan, Mathura, Sarnath, Chitrakoot, Ayodhya, Hastinapur, Allahabad, Vindhyachal, and more.Uttar Pradesh boasts a multitude of significant Hindu pilgrimage sites, with Varanasi, located on the banks of the Ganges, being particularly well-known. Allahabad is famed for its confluence of the mythical rivers Ganga, Yamuna, and Saraswati, while Mathura is renowned as the birthplace of Lord Krishna, and Ayodhya holds significance as the birthplace of Lord Rama. Uttar Pradeshs appeal is not limited to Hinduism it also holds significance for Buddhists. Sarnath, Kushinagar, and Saraswati, where Lord Buddha delivered his first sermon, are among the worlds most renowned Buddhist pilgrimage destinations.In the realm of Islamic religious destinations, Uttar Pradesh is known for the mausoleums of Sufi saints, with Hazrat Salim Chistis shrine in FatehpurSikri and Dewa Sharif in Lucknow being prominent religious tourist attractions.This paper sheds light on religious tourism in Uttar Pradesh, delving into its existing policies and frameworks centered around the states religious sites. It underscores how the religious tourism industry contributes revenue to the state by offering religious services, transportation options, accommodation facilities, and more. However, its essential to recognize that the religious tourism industry faces challenges due to inadequate understanding, insufficient policies, limited management, inadequate infrastructure, the absence of regulations, and a lack of environmental and cultural sustainability at these religious tourism destinations.

Real-World Use of Recombinant Von Willebrand Factor in People with Clinically Severe Congenital Von Willebrand Disease: Interim Analysis of Athn 9: A Natural History Study for People with Severe VWD

Background: People with von Willebrand disease (VWD) present with a spectrum of bleeding patterns and clinical symptoms, independent of subtype (Rugeri. Haematologica. 2007; Kalot. Haemophilia. 2021). In certain situations, prophylaxis may be appropriate, particularly when there is recurrent and severe bleeding (Connell, Blood Advances, 2021). There are limited real-world data on the use of recombinant von Willebrand factor (rVWF) in the United States. Aim: To characterize the safety and real-world effectiveness of routine prophylaxis with rVWF in people with clinically severe congenital VWD. Study Design and Methods:This is an interim analysis of a phase 4, longitudinal, prospective, observational cohort study (NCT03853486). Participants with severe VWD types 1, 2, and 3 (≤30% of normal) or “clinically severe VWD” (≤40% of normal with severe bleeding and requiring prophylaxis with factor concentrates) were identified from the ATHNdataset. The American Thrombosis & Hemostasis Network (ATHN) is the steward of the ATHNdataset, a Health Insurance Portability and Accountability Act-compliant, de-identified patient health dataset containing data from individuals with bleeding disorders receiving care through ATHN affiliates who opt in to contribute. Treatment regimens were at the discretion of each participant's respective bleeding disorder provider. Participants are followed for 2 years from the time of enrollment. Safety was measured using definitions from the European Haemophilia Safety Surveillance program. Bleeding events (BEs) were measured by individual bleeding components and calculated per the International Society on Thrombosis and Haemostasis Bleed Assessment Tool and/or the Pictorial Bleeding Assessment Chart. Health-related quality of life measures, including an ATHN9 rVWF substudy form, were used to describe real-world effectiveness of rVWF treatment. Descriptive statistics were used to analyze study outcomes. This study was not designed to detect differences in safety or efficacy between individual treatment products. Interim Results:As of June 16, 2023, 23 participants enrolled in the ATHN9 study were receiving rVWF; 14 participants have been prescribed rVWF for at least 1 full year, 13 of whom received continuous prophylaxis. This abstract reports on those 13 participants in the first year of the study. Mean (SD) age was 42.9 (29.2) years; 69.2% (n=9) of participants were female. Most participants had no comorbidities. As expected, most participants had a family history of VWD (84.6%; n=11) and no documented VWF inhibitors (84.6%; n=11); inhibitor status for the remaining 2 participants was unknown. Baseline VWF and factor VIII measurements were reported for most participants ( Table 1). The majority had type 2 VWD (84.6%; n=11), 92.3% (n=12) had identifiable genetic sequence defects in VWF, and 30.8% (n=4) had an abnormal VWF multimer profile. As dictated by the local investigator, rVWF prophylactic regimens ranged from 36.6 IU/kg once weekly to 57.6 IU/kg every 3 days; 7 (53.8%) participants received 40-60 IU/kg at a frequency of 2-3 times per week. Twenty-one BEs occurred in 5 (38.5%) of the participants receiving rVWF prophylaxis during the first year ( Table 2). Most BEs were spontaneous (61.9%; 13/21), occurring in the nose (n=7), gastrointestinal tract (n=5), or ankle (n=1). The remaining BEs were associated with activity with no known trauma (n=4), trauma (n=2), or unknown cause (n=2). One participant reported 3 rVWF treatment-unrelated adverse events (AEs) of humerus shaft closed fracture, metabolic encephalopathy, and acute exacerbation of chronic obstructive airways disease. When surveyed about their experience with rVWF, participants reported very or extremely satisfied as follows: 76.9% (n=10) with infusion time, 84.6% (n=11) with breakthrough bleed control time, 46.2% (n=6) with number of infusions required for breakthrough bleed control, and 69.2% (n=9) with frequency of achieving bleed control without concomitant hemostatic medication. Discussion:In participants with clinically severe congenital VWD, continuous prophylaxis with rVWF was associated with minimal AEs. Most participants receiving rVWF prophylaxis experienced no BEs during the first year of the study. Most participants expressed overall satisfaction with the use of rVWF.

Sustained benefits of early childhood education and care (ECEC) for young children’s development during COVID-19

Early childhood education and care (ECEC) settings faced significant disruption during the COVID-19 pandemic, compromising the continuity, stability and quality of provision. Three years on from the first UK lockdown as pandemic-era preschoolers enter formal schooling, stakeholders are concerned about the impact of the disruption on children’s cognitive and socioemotional development, especially those from socioeconomically disadvantaged backgrounds. Using parent-report data from 171 children aged 5 to 23 months ( M = 15 months) in March to June 2020 living in the UK, we investigate whether previously attested positive associations between ECEC attendance and the development of language and executive functions was maintained as early years settings navigated operational challenges over the first full year of the pandemic. In response to concerns about ‘school readiness’, we analyse the relationship between ECEC attendance and children’s communication, problem-solving and personal-social development. ECEC was associated with greater growth in receptive vocabulary over the 12-month period. In children from less advantaged backgrounds, ECEC was also associated with greater growth in expressive vocabulary. Our data suggest a similarly positive association between ECEC attendance and the communication and problem-solving skills of children from less advantaged backgrounds and between ECEC and the personal-social development of all children. Overall, results suggest that ECEC had sustained learning benefits for children growing up during the pandemic despite ongoing disruption to settings, with specific benefits for children from less affluent home environments. As pandemic-era children progress to primary school, we discuss the importance of adapting their learning conditions and adjusting the expectations placed on them.

2313. Population-based Incidence of SARS-CoV-2-associated Hospitalizations across the Age Spectrum in New York City, 2020-2021

Abstract Background Population-based incidence rates for hospitalizations due to SARS-CoV-2 can provide an increased understanding of the impact of transmission and mitigation strategies over time, yet there are relatively few estimates of such rates. Thus, we conducted a population-based, surveillance study to estimate incidence rates of SARS-CoV-2 hospitalizations among patients across the age spectrum. Methods From March 2020 to December 2021, we retrospectively reviewed the electronic medical records of patients admitted to an academic, multi-hospital system in New York City (NYC) to determine population-based incidence rates. Eligible patients resided in the pre-defined surveillance area, had ≥2 acute symptoms, and had laboratory-confirmed SARS-CoV-2 infection detected within 14 calendar-days prior to admission to 2 calendar-days after admission. Overall and age group incidence of SARS-CoV-2 hospitalization per 100,000 persons living in the surveillance area were calculated using 2020 census data, adjusted by hospital market share. Results From 2020-2021, 3,283 eligible patients were hospitalized with SARS-CoV-2 at the study hospitals. Patients’ median age in 2020 was 69 years (IQR 56, 80) and in 2021 was 67 years (IQR 51, 79) and 2.5% were 0-17 years old. Overall, 52% were male and 11%, 10%, and 61% were Black, White, and Hispanic, respectively. An estimated 1-4% of adults in age groups >65 years living in the surveillance area were hospitalized (Table). From 2020 to 2021, the overall population-based annual incidence rate and annual incidence rates in age groups 50-64, 65-74, 75-84, and ≥85 years decreased. While not significant, the incidence rate increased in patients 0-14 years. Conclusion These population-based incidence rates provide unique insights into the SARS-CoV-2 burden in a predefined surveillance area in NYC which served as the epicenter of the first U.S. wave of the pandemic. While incidence rates decreased in those >50 years old, rates were largely unchanged in those < 50 years old suggesting that younger adults and children had continued and potentially increased exposures to SARS-CoV-2 and/or lower vaccination rates than older adults during the second full year of the pandemic. Such incidence data can measure the impact of mitigation strategies. Disclosures Lisa Saiman, MD MPH, Merck & Co., Inc,: Grant/Research Support|Merck & Co., Inc,: Member, DSMB|Pfizer, Inc: Member, DSMB Edward E. Walsh, MD, Icosavax: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Moderna: Advisor/Consultant|Pfizer: Grant/Research Support Angela R. Branche, MD, Cyanvac: Grant/Research Support|GSK: Advisor/Consultant|Janssen: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support Julia A. Schillinger, MD, MSc, Merck & Co.: Employee, Stocks and Bonds MATTHEW R. PHILLIPS, MPH, Merck & Co., Inc., Rahway, NJ, USA: Employee|Merck & Co., Inc., Rahway, NJ, USA: Stocks/Bonds Lynn Finelli, DrPH, MS, Merck&Co: Stocks/Bonds

DNA and scale reading to identify repeat spawning in Atlantic salmon: Unique insights into patterns of iteroparity.

Iteroparity represents an important but often overlooked component of life history in anadromous Atlantic salmon. Here, we combined individual DNA profiling and scale reading to identify repeat spawners among ~8000 adult salmon captured in a fish trap in the river Etne, Norway, in the period 2015-2019. Additionally, 171 outward migrating kelts were captured in the spring of 2018-2020 and identified using molecular methods to estimate weight loss since ascending the river to spawn. The overall frequency of repeat spawners identified using molecular methods and scale reading combined was 7% in females and 3% in males (5% in total). Most of these (83%) spent one full year reconditioning at sea before returning for their second spawning, with a larger body size compared with their size at first spawning, gaining on average 15.9 cm. A single female migrating back into the river for a fifth breeding season was also identified. On average, kelts lost 40% bodyweight in the river, and more female than male kelts were captured during outward migration. The date of arrival in the upstream fish trap was significantly but moderately correlated between maiden and second entry to the river for alternate and consecutive spawners. The estimated contribution from repeat spawners to the total number of eggs deposited in the river each year varied between 2% and 17% (average 12%). Molecular-based methods marginally underestimated the number of repeat spawners compared with scale reading (5% vs 7%) likely due to a small number of returning spawners not being trapped and sampled. Differences between the methods were most evident when classifying the spawning strategy (alternate or consecutive-year repeat spawners), where the scale method identified proportionally more consecutive-year repeat spawners than the molecular method. This unique data set reveals previously unstudied components of this life history strategy and demonstrates the importance of repeat spawners in population recruitment.

Observed Warming Trends at U.S. Army Basic Combat Training Installations andImplications forFuture Recruit Training.

Army recruits conducting BCT are among the most susceptible population of military personnel to experience exertional heat illness, a concern expected to become increasingly urgent due to steadily rising temperatures. In this study, we provide an empirical analysis of wet bulb globe temperature (WBGT) index trends at U.S. Army BCT installations and quantify the magnitude of these trends. Assuming these warming trends continue, the anticipated effects of increasing temperature trends are discussed in relation to potential impacts on recruit heat illness incidence and training disruption. We obtained weather data beginning in the early 1960s, including WBGT index measurements derived by the U.S. Air Force 14th Weather Squadron. We apply these datasets to two classifications for high WBGT index days, including one classification accounting for heat illness susceptibility based on prior day heat exposure, to determine when recruits are most at risk of heat illness. The daily likelihood of extreme WBGT index values is described at each installation using a 30-year climatological average. Trends in the WBGT index are evaluated quantitatively during the warm season (May 1-September 30) and full year and compared between decades and by individual BCT classes. Trends in the WBGT index have increased at all four BCT installations. Between January 1960 and October 2022, the mean WBGT index value increased most quickly at Ft Jackson, SC (0.272°C decade-1, CI: 0.255-0.289) and least at Ft Moore, GA (0.190°C decade-1, CI: 0.170-0.210). Ft Moore experiences the greatest heat burden, with the daily likelihood of experiencing a "black flag" event (≥90°F WBGT index) peaking at nearly 50% in late July, while Ft Leonard Wood, MO, experiences the least heat burden. This heat burden is spread unevenly across installations and dependent on BCT class start date. Recruits beginning in mid-June will experience approximately 200 hours of hazardous heat during BCT at Ft Moore, GA; 100 hours at Ft Jackson, SC; 80 hours at Ft Sill, OK; and 61 hours at Ft Leonard Wood, MO. Temperatures measured on the WBGT index have steadily increased at US Army basic training installations since at least 1960. In the future, adaptation to the BCT program will be required to maintain rigorous standards without incurring unacceptable risk of recruit heat illness. The analysis provided by this study can help inform medical, training, and policy implementations needed to ensure continued BCT in a warming world.

Significant but transient: The impact of an energy saving app targeting Swiss households

In Global North countries, persuasive apps supporting households in reducing their energy consumption are widespread, as promising policy tools for the energy and climate transition. Despite their growing diffusion, fed by the large-scale smart meter roll-out currently ongoing in many energy systems, rigorous studies providing evidence on their effects are still missing, especially for the long-term. We address this research gap by analysing a one-year long app-based electricity saving intervention performed in Switzerland between 2018 and 2019, involving 55 self-selected households. Adopting a quasi-experimental approach and considering four full years of energy consumption data, we estimate the app’s average treatment effect over time and perform heterogeneity analyses on household sub-groups, on varying their characteristics and intensity of app use. The app reduced consumption and CO2 emissions during the intervention (average treatment effect on the treated equal to 4.95%, statistically significant at the 0.05 level; Cohen’s d effect size equal to 0.35). However, one year later the effect disappeared. Our results put policies based on persuasive app use into perspective: taken in isolation, persuasive apps may exhibit limitations regarding long-lasting effects. To avoid relapse, future interventions might embed app use into broader processes explicitly aimed at redefining shared norms and conventions on household energy consumption practices, for instance within living lab processes.

Increased functional connectivity in the right dorsal auditory stream after a full year of piano training in healthy older adults

Learning to play an instrument at an advanced age may help to counteract or slow down age-related cognitive decline. However, studies investigating the neural underpinnings of these effects are still scarce. One way to investigate the effects of brain plasticity is using resting-state functional connectivity (FC). The current study compared the effects of learning to play the piano (PP) against participating in music listening/musical culture (MC) lessons on FC in 109 healthy older adults. Participants underwent resting-state functional magnetic resonance imaging at three time points: at baseline, and after 6 and 12 months of interventions. Analyses revealed piano training-specific FC changes after 12 months of training. These include FC increase between right Heschl’s gyrus (HG), and other right dorsal auditory stream regions. In addition, PP showed an increased anticorrelation between right HG and dorsal posterior cingulate cortex and FC increase between the right motor hand area and a bilateral network of predominantly motor-related brain regions, which positively correlated with fine motor dexterity improvements. We suggest to interpret those results as increased network efficiency for auditory-motor integration. The fact that functional neuroplasticity can be induced by piano training in healthy older adults opens new pathways to countervail age related decline.

An appraisal of the practice of duplicate testing for the detection of irregular analytical errors.

Our study aimed to determine the usefulness of duplicate testing in identifying irregular analytical errors and subsequent prevention of patient mismanagement. In our laboratory, all requests for Na+, Ca2+, alkaline phosphatase (ALP), and high-sensitivity cardiac-troponin-I (hs-cTnI) are run in duplicate. Data from four separate weeks for Na+ (n=21,649), Ca2+ (n=14,803) and ALP (n=19,698); and a full year for hs-cTnI (n=17,036) were gathered. For each test, pre-defined limits for differences between duplicates were used to identify erroneous results (Fliers). We further characterised a subset of such fliers as "critical errors", where duplicates fell on opposing sides of a reference/decision making threshold. The costs/benefits of running these tests in duplicate were then considered in light of increased number of tests analysed by this approach. For Na+, 0.03 % of duplicates met our flier defining criteria, and 0.01 % of specimens were considered critical errors. For Ca2+ requests, 4.58 % of results met our flier defining criteria and 0.84 % were critical errors. For ALP, 0.22 % of results were fliers, and 0.01 % were critical errors. For hs-cTnI, 1.58 % of results were classified as fliers, whilst 0.14 % were classified as a critical error. Depending on the test in question, running all analyses in duplicate increased annual costs by as little as €1,100 (for sodium), and as much as €48,000 (for hs-cTnI). Duplicate testing is effective at identifying and mitigating irregular laboratory errors, and is best suited for assays predisposed to such error, where costs are minimal, and clinical significance of an incorrect result can justify the practice.

A comparative evaluation of Elo ratings- and machine learning-based methods for tennis match result prediction

Elo ratings-based methods, including the recently proposed Weighted Elo method, have been found to perform well when forecasting tennis match results, however, whether they can outperform machine learning (ML) has not been established. In this study, a comparative evaluation of the two types of methods is conducted using the Sports Result Prediction CRISP-DM experimental framework. The first full year of mens ATP tennis data (2006), in a dataset containing matches from 2005 to 2020, was set to be the initial training set and 1 year of data was incrementally added to this set to predict 14 test years, from 2007 to 2020. Features were ranked based on their average rank across five feature selection techniques. It was found that, of the five ML models, Alternating Decision Trees (ADTrees) and Logistic Regression achieved higher accuracies than Elo ratings and similar accuracies to predictions derived from betting odds. Furthermore, ADTrees show potential in this domain, with solid performance achieved with an interpretable decision tree that allows for variation in the average betting odds difference threshold.

Analysis of tariff agreements of the constituent entities of the Russian Federation: form and completeness of data presentation

Background. Each constituent entity of the Russian Federation (RF) on the basis of the territorial programme of state guarantees of free medical care for citizens forms a tariff agreement (TA) on payment for medical care. Despite the list of requirements to the content and structure of the tariff agreement established by the decree of the Ministry of Health of the RF, there are significant differences among the regional tariff agreements in terms of content and completeness of the information provided.Objective: a comparative analysis of TA of the RF constituent entities and additional agreements to them to identify differences in their structure and content.Material and methods. To carry out the analysis, the data of TA for the full calendar year 2022 were systematised into a single database with the allocation of the main parameters regulated by legal documents. On the basis of the database, the availability and form of information presentation in the TA were analysed.Results. The differences were revealed, which can be divided into two groups. In the first group, they relate to the content and structure of TA; in the second group, to the presentation of TA in public domain. The differences are related to the information content of TA, details of tariffs for medical services, the presence or absence of tariffs for separate medical services, as well as the presentation and formats of TA files on the websites of territorial compulsory health insurance funds.Conclusion. To date, there are still a significant number of differences between TA of the RF constituent entities. The lack of unification in data presentation in the regions increases the risk of errors in comparative analysis, which may ultimately affect the correctness of its results presented to the authorities for decision-making in the health care sector. The new unified form of TA will make it possible to eliminate the above-mentioned differences in content and presentation by bringing the data to a single format.

Aerosol and dynamical contributions to cloud droplet formation in Arctic low-level clouds

Abstract. The Arctic is one of the most rapidly warming regions of the globe. Low-level clouds and fog modify the energy transfer from and to space and play a key role in the observed strong Arctic surface warming, a phenomenon commonly termed “Arctic amplification”. The response of low-level clouds to changing aerosol characteristics throughout the year is therefore an important driver of Arctic change that currently lacks sufficient constraints. As such, during the NASCENT campaign (Ny-Ålesund AeroSol Cloud ExperimeNT) extending over a full year from October 2019 to October 2020, microphysical properties of aerosols and clouds were studied at the Zeppelin station (475 m a.s.l.), Ny-Ålesund, Svalbard, Norway. Particle number size distributions obtained from differential mobility particle sizers as well as chemical composition derived from filter samples and an aerosol chemical speciation monitor were analyzed together with meteorological data, in particular vertical wind velocity. The results were used as input to a state-of-the-art cloud droplet formation parameterization to investigate the particle sizes that can activate to cloud droplets, the levels of supersaturation that can develop, the droplet susceptibility to aerosol and the role of vertical velocity. We evaluate the parameterization and the droplet numbers calculated through a droplet closure with in-cloud in situ measurements taken during nine flights over 4 d. A remarkable finding is that, for the clouds sampled in situ, closure is successful in mixed-phase cloud conditions regardless of the cloud glaciation fraction. This suggests that ice production through ice–ice collisions or droplet shattering may have explained the high ice fraction, as opposed to rime splintering that would have significantly reduced the cloud droplet number below levels predicted by warm-cloud activation theory. We also show that pristine-like conditions during fall led to clouds that formed over an aerosol-limited regime, with high levels of supersaturation (generally around 1 %, although highly variable) that activate particles smaller than 20 nm in diameter. Clouds formed in the same regime in late spring and summer, but aerosol activation diameters were much larger due to lower cloud supersaturations (ca. 0.5 %) that develop because of higher aerosol concentrations and lower vertical velocities. The contribution of new particle formation to cloud formation was therefore strongly limited, at least until these newly formed particles started growing. However, clouds forming during the Arctic haze period (winter and early spring) can be limited by updraft velocity, although rarely, with supersaturation levels dropping below 0.1 % and generally activating larger particles (20 to 200 nm), including pollution transported over a long range. The relationship between updraft velocity and the limiting cloud droplet number agrees with previous observations of various types of clouds worldwide, which supports the universality of this relationship.

The economic impacts of integrating European balancing markets: The case of the newly installed aFRR energy market-coupling platform PICASSO

The coupling of European balancing markets is one of the latest steps towards integrating Europe’s internal electricity market. From mid-2022 onwards, besides imbalance netting, the activation of the automated frequency restoration reserves (aFRR) has also been increasingly integrated between European transmission system operators (TSOs) in the so-called PICASSO framework. The possible benefits of this balancing market integration include cost savings and a reduced use of activation energy.The goal of this paper is to quantify the effects of the joint activation of balancing power in European markets in terms of welfare gains and increases in consumer rents due to lower prices. The paper also aims to demonstrate the reduced use of activation energy under the latest market-coordination framework. For this purpose, the coupling of aFRR markets is modelled by formulating and solving the optimisation problems for economic activation using linear programming. A PICASSO market structure with imbalance netting and cross-border activation of reserves is compared to the non-collaborative reference arrangement and to the existing IGCC set-up with imbalance netting only. A case study of the Belgian, Dutch and German electricity systems is modelled over a full year using historic data from 2021. The study indicates overall welfare gains of €400 million per year, the same order of magnitude as the increase in economic welfare of earlier balancing platforms such as TERRE. In addition, the cross-border effects on activation volumes and prices and their distributional effects are discussed. The results suggest that within the three countries, the primary beneficiaries of PICASSO are balancing service providers in the Netherlands and Belgium, and consumers in Germany.

Quantitative analysis of the Martian atmospheric dust cycle: Transported mass, surface dust lifting and sedimentation rates

The atmospheric dust cycle on Mars plays a dominant role in the planetary radiative balance, atmospheric photochemistry escape, and redistribution of materials on the surface. Although this planetary dust cycle has been extensively modelled and characterized with both orbital and in situ observations, to date little is known about the total mass of dust that is circulated, the actual dust lifting and settling rates, and the main dust sources and sinks. Using orbital global and seasonal measurements of atmospheric dust opacity, a data reduction methodology that can describe the annual dust redistribution cycle on a planetary scale with 95% accuracy is presented. The method was applied to the 9.3 μm infrared observations of the Thermal Emission Spectrometer (TES) aboard the Mars Global Surveyor (MGS) during two full Martian Years (MY) 25 and 26, and partly MY 24 and MY 27, disregarding the global dust storm that occurred in MY 25. By comparison with terrestrial observations, a mass-to-extinction conversion factor of 1.9 ± 0.3 g m−2 is proposed, assuming a dust density of 2.6 g cm−3. The analysis shows an estimation of 400 1012 g of dust transported globally in the atmosphere for a typical Mars year, which is comparable to the minimum total annual mass of dust transported on Earth. The methodology proposed here is based on remote sensing and cannot disentangle completely local surface lifting and sedimentation rates from dust advection. However, this analysis provides upper bounds which can be compared with in-situ observations. The analysis of the dust sedimentation cycle suggests that the annual cycle might produce a dust layer of about 50–100 μm on the surface of some particular zones, as Valle Marineris or Meridiani Planum. This estimation agrees with in-situ observations of rovers on Mars. The potential dust sources are mainly located from latitudes of 20°S to 60°S. Our results find the 70% of the sources previously identified by the existing planetary circulation models. This kind of large-scale analysis can be applied to other remote sensing observations to refine these calculations and study the annual and geographical variability of the dust-mass transport on Mars.

Racial and geographic disparities in the use of molecular testing among older Medicare beneficiaries with lung cancer.

125 Background: The National Comprehensive Cancer Network (NCCN) guidelines recommend comprehensive molecular testing for newly diagnosed patients with metastatic non-small cell lung cancer (mNSCLC). However, the uptake of the next-generation sequencing (NGS) tests for NSCLC was low due to lack of insurance coverage. In 2018, the Centers for Medicare & Medicaid Services issued a national coverage determination to cover diagnostic laboratory tests using NGS for Medicare beneficiaries with advanced cancer. It is important to understand the current uptake of the NGS tests among older Medicare beneficiaries with lung cancer and examine the potential racial and geographic disparities in the use of NGS tests. Methods: From the random 20% sample of all Medicare beneficiaries, we selected Medicare beneficiaries who were 66 years and older and newly diagnosed with lung cancer in 2020. We excluded beneficiaries who were ever diagnosed with breast, colorectal, endometrial, lung, or prostate cancer before 2020 and beneficiaries who died in 2020. We further restricted our sample to those with a full year of Medicare Part A and B coverage and no month of Medicare Advantage coverage. We identified molecular testing for our lung cancer cohort using Medicare carrier and outpatient claims. We used two linear probability models to examine the relationship between race and the receipt of any molecular tests among all lung cancer patients (N=9,229), and the relationship between race and the receipt of panel tests among those received any molecular tests (N=1,842). We adjusted for age at the beginning of 2020, sex, Medicaid enrollment (low-income), geographic region, and common pre-existing chronic conditions (Alzheimer’s and related dementia, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, depression, ischemic heart disease, and arthritis). Results: Among 9,229 older lung cancer patients newly diagnosed in 2020, 1,842 (19.96%) of them received molecular tests. Among those 1,842 who received molecular tests, 709 (38.49%) of them received NGS tests, and the rest received single-gene tests only. In our regression analyses, we found Asian patients were 12.5-percentage point more likely to receive any molecular tests compared to White patients. Among those received any tests, Hispanic patients were 16.0-percentage point less likely to receive NGS tests over single-gene tests compared to White patients. We also found those residing in the South and the West were less likely to receive NGS tests over single-gene tests than those residing in the Northeast. Conclusions: Given the guideline recommendation and proportion of new mNSCLC cases among all new lung cancers, there was likely underuse of NGS tests. There were also racial and geographic disparities in the use of NGS tests.

Supplemental oxygen does not improve growth but can enhance reproductive capacity of fish.

Fish tend to grow faster as the climate warms but attain a smaller adult body size following an earlier age at sexual maturation. Despite the apparent ubiquity of this phenomenon, termed the temperature-size rule (TSR), heated scientific debates have revealed a poor understanding of the underlying mechanisms. At the centre of these debates are prominent but marginally tested hypotheses which implicate some form of 'oxygen limitation' as the proximate cause. Here, we test the role of oxygen limitation in the TSR by rearing juvenile Galaxias maculatus for a full year in current-day (15°C) and forecasted (20°C) summer temperatures while providing half of each temperature group with supplemental oxygen (hyperoxia). True to the TSR, fish in the warm treatments grew faster and reached sexual maturation earlier than their cooler conspecifics. Yet, despite supplemental oxygen significantly increasing maximum oxygen uptake rate, our findings contradict leading hypotheses by showing that the average size at sexual maturation and the adult body size did not differ between normoxia and hyperoxia groups. We did, however, discover that hyperoxia extended the reproductive window, independent of fish size and temperature. We conclude that the intense resource investment in reproduction could expose a bottleneck where oxygen becomes a limiting factor.