Differences Research Articles

Trends and socio-demographic determinants of suicide-related mortality in Türkiye: An epidemiological study from 2009 to 2022.

Suicide is a leading cause of death, particularly among the young age group, in Türkiye, a country with a high population of young people. The aim of this study is determine the suicide related mortality trend and some associated socio-demographic factors in Türkiye between 2009 and 2022. The study includes an epidemiological trend on suicide. The Turkish Statistical Institute's data portal was used. The study population is 46,691 people (Male/female ratios = 74.6%/ 25.4%). Changes in mortality trends were evaluated using the Joinpoint Regression method with Annual Percentage Change (APC) and Average Percentage Change (AAPC) analysis. Over the past 14 years in Türkiye, there has been a statistically significant increase in the standardized mortality rate among males (2009-2022 APC = .76, p = .012) and a statistically non-significant decrease among females (2009-2022 APC = -1.62, p = .083). According to the Nomenclature of Territorial Units for Statistics (NUTS-1) classification, the highest increase is observed in the Central Anatolia region followed by the Western Black Sea region (APC = 3.0 and 2.7, respectively; p < .005). While the percentage of primary school and below has decreasing trends (2009-2022 APC = -7.11, p < .005), there is a significant increase in the percentage of university graduates (2009-2016 APC = 10.87, p < .001). Regarding the marital status, there is a significant decrease in the percentage of those who are married (2009-2013 APC = -3.36, p < .001; 2013-2016 APC = 2.42, p = .037; 2016-2022 APC = -2.31, p = .003) and a significant increase in those who have never been married (2009-2013 APC = 2.63, p < .001; 2013-2016 APC = -1.36, p = .002). Although suicide related mortality is below the global average, there has been an increasing trend in turkey in the last 14 years. Analytical and intervention studies on the socio-demographic determinants supporting the increasing trend are needed.

The Diabetes Technology Society Error Grid and Trend Accuracy Matrix for Glucose Monitors.

An error grid compares measured versus reference glucose concentrations to assign clinical risk values to observed errors. Widely used error grids for blood glucose monitors (BGMs) have limited value because they do not also reflect clinical accuracy of continuous glucose monitors (CGMs). Diabetes Technology Society (DTS) convened 89 international experts in glucose monitoring to (1) smooth the borders of the Surveillance Error Grid (SEG) zones and create a user-friendly tool-the DTS Error Grid; (2) define five risk zones of clinical point accuracy (A-E) to be identical for BGMs and CGMs; (3) determine a relationship between DTS Error Grid percent in Zone A and mean absolute relative difference (MARD) from analyzing 22 BGM and nine CGM accuracy studies; and (4) create trend risk categories (1-5) for CGM trend accuracy. The DTS Error Grid for point accuracy contains five risk zones (A-E) with straight-line borders that can be applied to both BGM and CGM accuracy data. In a data set combining point accuracy data from 18 BGMs, 2.6% of total data pairs equally moved from Zones A to B and vice versa (SEG compared with DTS Error Grid). For every 1% increase in percent data in Zone A, the MARD decreased by approximately 0.33%. We also created a DTS Trend Accuracy Matrix with five trend risk categories (1-5) for CGM-reported trend indicators compared with reference trends calculated from reference glucose. The DTS Error Grid combines contemporary clinician input regarding clinical point accuracy for BGMs and CGMs. The DTS Trend Accuracy Matrix assesses accuracy of CGM trend indicators.

Transiently worse postural effects after vestibulo-ocular reflex gain-down adaptation in healthy adults.

Suffering an acute asymmetry in vestibular function (i.e., vestibular neuritis) causes increased sway. Non-causal studies report associations between lateral semicircular canal function and balance ability, but direct links remain controversial. We investigate the immediate effect on body sway after unilateral vestibulo-ocular reflex (VOR) gain down adaptation simulating acute peripheral vestibular hypofunction. Eighteen healthy adults, mean age 27.4 (± 12.4), stood wearing an inertial measurement device with their eyes closed on foam before and after incremental VOR gain down adaptation to simulate mild unilateral vestibular neuritis. Active head impulse VOR gain was measured before and after the adaptation to ensure VOR gain adaptation. Percentage change for VOR gain was determined. Sway area was compared before and after VOR adaptation. VOR gain decreased unilaterally exceeding meaningful change values. Sway area was significantly greater immediately after VOR gain down adaptation, but quickly returned to baseline. In a subset of subjects VOR gain was re-assessed and found to remain adapted despite sway normalization. These results indicate that oculomotor adaptation targeting the lateral semicircular canal VOR pathway has an immediate, albeit transient increase in body sway. Rapid return of body sway to baseline levels suggests dynamic sensory reweighting between vestibular and somatosensory inputs to resolve the undesirable increased body sway.

Neonatal birthweight prediction using two- and three-dimensional estimated fetal weight among borderline small fetuses.

This study aimed (1) to determine the degree of correlation between 2D and 3D estimated fetal weight (EFW) and neonatal birth weight (BW) among borderline small fetuses and (2) to compare the accuracy and precision of 2D and 3D EFW in BW prediction. A retrospective cohort study evaluated fetuses who had an ultrasound performed between January 2017 and September 2021 at a tertiary maternal center. All singleton pregnancies with 3D EFW within 4 weeks of delivery were included. Fetuses with known structural or genetic abnormalities were excluded. Pearson's correlation coefficients were determined for both 2D and 3D EFW to BW then compared using Williams' test and Fisher r to z transformation, where applicable. Mean percent difference and standard deviation were used to assess the accuracy and precision, respectively, of 2D and 3D EFWs in BW prediction. Two hundred forty-eight pregnancies were included. Ultrasound studies were performed with a median interval of 2 weeks (IQR 1, 3) between ultrasound and delivery. Both 2D and 3D estimated fetal weights showed a significant correlation with birth weight (r = 0.74 and r = 0.73, respectively), indicating similar accuracy between the two techniques. Two-dimensional and three-dimensional EFWs performed similarly in the prediction of BW in borderline small fetuses.

Remote sensing of turbid coastal and estuarine waters with VIIRS I (375 m) and M (750 m) bands

ABSTRACT The Visible Infrared Imaging Radiometer Suite (VIIRS) is a visible, near and shortwave, to thermal infrared multispectral scanning instrument operational on three polar orbiting satellites, Suomi-NPP, JPSS-1, and JPSS-2. In the present paper, the processing of VIIRS using ACOLITE is introduced, using the Dark Spectrum Fitting (DSF) algorithm for processing of the visible to shortwave infrared bands. ACOLITE now includes support for processing both the imaging (I) and moderate (M) resolution bands at 375 m and 750 m spatial resolution, respectively. In most conditions encountered in the present study, the SWIR bands (either I or M) are automatically selected by the DSF for performing the aerosol correction. The processing is evaluated for turbid water remote sensing via autonomous hyperspectral radiometry from four sites across coastal and estuarine waters: two sites in Belgium and one each in France and Argentina. Through analysis of hundreds of matchups between the satellite and in situ measurements, a generally good performance is found for both I and M bands, especially for bands with the largest water signal, i.e. bands between 490 and 670 nm, where on average relative differences of 10–15% were found. Reflectance biases are generally less than 0.01, with a negative sign in the green and red bands and a positive sign in the blue and NIR bands. Similar matchup results are found for the I and M red and NIR bands, with a slightly higher scatter for the NIR bands. An additional comparison with OCSSW/l2gen processing of the M band data is performed for various configurations. Overall, DSF performance is better in the visible bands, whereas l2gen outputs are more closely aligned with the in situ measurements in the NIR. On average, negative biases are found for all l2gen configurations, up to −0.02 in the blue bands. Using either the SWIR1 + 2 or SWIR1 + 3 bands for the aerosol correction gives the best performance for l2gen processing. For the three VIIRS instruments separately, the average spectral differences with in situ measurements are comparable, with the most important deviation occurring at the Suomi-NPP shortest blue bands, where DSF processing gives a larger positive bias, up to nearly 0.02. For these bands, results from l2gen correspond more closely across the three instruments – although with significant negative biases for all three sensors up to −0.02 – presumably due to the use of system vicarious calibration gains in that processor. An operational network of autonomous hyperspectral instruments provides validation data for any overpassing optical imaging satellite in its commissioning or operational phase and eliminates the need for spectral interpolation or band shifting. In the case of VIIRS specifically, the hyperspectral instruments provide adequate data for the validation of the 20, 40 and 80 nm wide bands. With three operational wide-swath instruments, which provide largely interoperable data, a high frequency of observations is available, especially for study areas at higher latitudes. The novel exploitation of the I bands is now possible, thanks to the free and open source availability of ACOLITE. The advantage of the higher resolution I band data, combined with multiple VIIRS overpasses per day, is demonstrated for mapping turbidity in nearshore regions with high spatial variabilty and for detecting under-resolved floating algae.

The burden of type 2 diabetes attributable to dietary risks in China: Insights from the global burden of disease study 2021

ObjectivesThis study aims to comprehensively assess how dietary risk factors have influenced the prevalence of Type 2 Diabetes Mellitus (T2DM) in China from 1990 to 2021. The study seeks to provide robust data and scientific evidence essential for formulating effective preventive and control strategies to combat T2DM in China. Study designThis cross-sectional study conducted secondary analyses using data from the Global Burden of Disease 2021 (GBD 2021) to assess the burden of T2DM in China attributable to dietary risks. MethodsThe study analyzed age-adjusted metrics related to T2DM, including death counts, Disability-Adjusted Life Years (DALYs), and Age-Standardized Rates (ASRs), using GBD 2021 data, stratified by age and sex. Additionally, Estimated Annual Percentage Changes (EAPCs) were employed to track trends over time. ResultsIn 2021, the results show that 21.43 % of T2DM-related deaths and 23.51 % of DALYs were attributable to dietary risk factors, notably a diet low in whole grains and high in red and processed meats. Over the period from 1990 to 2021, there has been an increasing trend in the EAPCs of death rates and DALYs associated with dietary risks in China, suggesting a substantial impact of dietary factors on the burden of T2DM in the country. ConclusionThis study highlights the urgent need for targeted public health interventions to promote dietary changes and reduce the burden of T2DM in China.

Pre-operative dual-time-point [18F]FET PET differentiates CDKN2A/B loss and PIK3CA mutation status in adult-type diffuse glioma: a single-center prospective study.

While [18F]FET PET plays a complementary role in glioma imaging, it needs to be more comprehensively understood for improved characterization of glioma prior to surgery given the evolving landscape of molecular neuropathology. Thus, we investigated the utility of pre-operative dual-time-point [18F]FET PET in correlation with next-generation sequencing (NGS) data in patients with adult-type diffuse glioma (ADG). Adult patients who were suspected to have primary glioma were prospectively recruited between June 2021 and January 2024. They underwent pre-operative dual-time-point static PET/CT at 20min (early) and 80min (delay) after [18F]FET injection. Semi-quantitative parameters of the hottest lesion (SUVmax) of tumour and the hottest lesion-to-normal brain ratio (TBRmax) were assessed from each summed image. Furthermore, the percentage changes (△) of SUVmax and TBRmax between two images were calculated. Histopathology of glioma was determined according to the 2021 WHO classification and NGS data. This study investigated a dozen genes in 76 patients, of whom 51 had isocitrate dehydrogenase (IDH)-wild-type glioblastoma, 13 had IDH-mutant astrocytoma, and 12 had IDH-mutant oligodendroglioma. Every tumour was [18F]FET-avid having TBRmax more than 1.6. Patients with CDKN2A/B loss had significantly higher values of SUVmax (5.7 ± 1.6 vs. 4.7 ± 1.3, p = 0.004; 5.0 ± 1.4 vs. 4.4 ± 1.2, p = 0.026) and TBRmax (6.5 ± 1.8 vs. 5.1 ± 1.7, p = 0.001; 5.3 ± 1.5 vs. 4.3 ± 1.3, p = 0.004) in both scans than patients without CDKN2A/B loss, even after adjustment for age, MRI enhancement, tumor grade and type of pathology. Furthermore, patients with PIK3CA mutation (16.2 ± 11.8 vs. 6.7 ± 11.6, p = 0.007) had significantly higher △SUVmax than patients without PIK3CA mutation, even after adjustment for age, MRI enhancement, tumor grade, and type of pathology. Among the dozen genes investigated in this prospective study in patients with ADG, we found out that CDKN2A/B loss and PIK3CA mutation status could be differentiated by pre-operative dual-time-point [18F]FET PET/CT.

Thermal and emission analysis of waste plastic and microalgae biodiesel as a potential power source for diesel engines: A sustainable approach.

The future of diesel engines is greatly influenced by ongoing research on alternative fuels. Renewable fuels have been researched and adopted by several nations to encourage the production and use of biodiesel. This study examines the energy conversion of waste plastic biodiesel and Spirulina microalgae biodiesel at a 20% blending ratio to analyze the behavior of a one-cylinder, 4-stroke diesel engine running at 1500rpm with a compression ratio of 17.5. The authors evaluated, analyzed, and compared the engine's combustion, performance, and emission at an incremental engine load of 25% from 25 to 100%. The findings demonstrated that the biodiesel fuel samples generated somewhat poorer efficiency but reduced emissions from the engine. At 100% load, the percentage differences between the diesel and blended fuel samplesranged from 2.4 to 7.3% for BTE, 2.9 to 16.5% for BSFC, and 1.0 to 4.62% for BSEC; however, the PM, SO2, and CO2 emissions were reduced by 1.6-28.8% except for NOx emissions, which are increased by up to 9.4%. Pure diesel exhibits the best performance characteristics; however, pure biodiesel exhibits the best emission characteristics. The 20% blended fuels showed promising results, as they exhibited comparable or slightly improved BTE values compared to their respective pure biodiesel fuels. The findings indicate that Spirulina microalgae biodiesel and waste plastic biodiesel have the potential to be utilized as substitute fuels for diesel engines; however, for the greatest performance and lowest emissions, their blending ratios and engine operating conditions must be optimized.

Diffusion in Polymethylene Chain Solutions with a Polar Component.

A hydrodynamic bead model based on Kirkwood-Riseman theory has been used to calculate the translational diffusion constant, D, for solutes with polymethylene chains in solutions with a polar component. A comparison with the experimental values for nonpolar n-alkanes in polar 2-propanol, tetrahydrofuran, chlorobenzene, chloroform, 1-octanol, quinoline, and chloroform (78 D values) and polar primary alcohols in nonpolar benzene and n-octane (24 D values) gives an average absolute percentage difference of ∼3% between the 102 experimental and calculated D values. Consideration of the solvent's temperature-dependent changes in the degree of aggregation due to hydrogen bonding was necessary for the n-alkanes in 1-octanol. Good agreement was not found for primary alcohols in 1-octanol due to solute-solvent hydrogen bonding. A correlation that depends on the solutes' molar volumes instead of their chain lengths gives worse agreement than the bead model for the n-alkanes in polar solvents and primary alcohols and n-alkanes in nonpolar solvents.

Evaluation of cumulative dose distributions from external beam radiation therapy using CT-to-CBCT deformable image registration (DIR) for cervical cancer patients.

To investigate dose differences between the planning CT (pCT) and dose calculated on pre-treatment verification CBCTs using DIR and dose summation for cervical cancer patients. Cervical cancer patients treated at our institution with 45Gy EBRT undergo a pCT and 5 CBCTs, once every five fractions of treatment. A free-form intensity-based DIR in MIM was performed between the pCT and each CBCT using the "Merged CBCT" feature to generate an extended FOV-CBCT (mCBCT). DIR-generated bladder and rectum contours were adjusted by a physician, and dice similarity coefficients (DSC) were calculated. After deformation, the investigated doses were (1) recalculated in Eclipse using original plan parameters (ecD), and (2) deformed from planning dose (pD) using the deformation matrix in MIM (mdD). Dose summation was performed to the first week's mCBCT. Dose distributions were compared for the bladder, rectum, and PTV in terms of percent dose difference, dose volume histograms (DVHs), and gamma analysis between the calculated doses. For the 20 patients, the mean DSC was 0.68±0.17 for bladder and 0.79±0.09 for rectum. Most patients were within 5% of pD for D2cc (19/20), Dmax (17/20), and Dmean (16/20). All patients demonstrated a percent difference>5% for bladder V45 due to variations in bladder volume from the pCT. D90 showed fewer differences with 19/20 patients within 2% of pD. Gamma rates between pD and ecD averaged 94% for bladder and 94% for rectum, while pD and mdD exhibited slightly better performance for bladder (93%) and lower for rectum (85%). Using DIR with weekly CBCT images, the MIM deformed dose (mdD) was found to be in close agreement with the Eclipse calculated dose (ecD). The proposed workflow should be used on a case-by-case basis when the weekly CBCT shows marked difference in organs-at-risk from the planning CT.

‘Effectiveness of various sulbactam-based combination antibiotic therapy in the management of ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in a tertiary care Health centre’

ObjectiveCarbapenem-resistant Acinetobacter baumannii (CRAB) is a common cause of ventilator-associated pneumonia (VAP). Some in vitro data favour various combination antibiotic therapy. However, there is a need for more in vivo studies for the management of VAP caused by CRAB. This retrospective study was done to evaluate the effectiveness of various combination antibiotic therapy including sulbactam on outcomes of VAP caused by CRAB. MethodsAdult patients (age ≥18 years) diagnosed with VAP caused by CRAB were included. Patients with polymicrobial infections were excluded from the study. Patients with CRAB associated VAP who were given sulbactam based antibiotic combinations were observed for outcomes. The primary outcome was 28-day mortality after diagnosis of VAP caused by CRAB. Reduction in serum HsCRP (High sensitivity C-reactive protein) during treatment and requirement of inotropes were the secondary outcomes. Outcomes were compared between various sulbactam based antibiotic combination therapies. ResultsA total of 103 patients were included. A total of 44 (42.7 %) patients received sulbactam and minocycline or sulbactam and polymyxin B dual antibiotic combination, and 59 (57.3 %) patients received sulbactam, polymyxin B and minocycline triple antibiotic combination. The percentage difference in 28 days mortality was 27.51 % (95 % CI 8.03 %–44.06 %; p = 0.005) in dual vs triple sulbactam based antibiotic combination therapy. The percentage difference in requirement of inotropes during therapy and HsCRP reduction after 7 days of therapy was 23.65 % (95 % CI 6.43 %–38.3 %; p = 0.007) and 25.1 % (95%CI 10.1 %–38.2 %; p < 0.001) respectively when compared between dual vs triple sulbactam based antibiotic combination therapy. ConclusionTreatment with sulbactam, polymyxin B and minocycline combination antibiotic therapy was associated with significantly lower 28-day mortality. Moreover, the lower requirement of inotropes during treatment and a significant reduction in HsCRP level favours this combination antibiotic therapy in VAP caused by CRAB.

Global, regional, and national burden of pancreatitis in children and adolescents.

Pancreatitis poses a growing public health concern among children and adolescents, yet comprehensive data on its prevalence, incidence, mortality, and disability-adjusted life years (DALYs) remain scarce. This study aims to analyze global, regional, and national trends in pancreatitis burden over the past 3decades. Using data from the Global Burden of Disease (GBD) 2019 database spanning 1990-2019, we assessed pancreatitis prevalence, incidence, mortality, and DALYs, reporting on numbers, rates, age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized DALYs rate (ASDR), and average annual percentage changes (AAPCs). Trends were analyzed by age, sex, region, and socio-demographic index (SDI) using jointpoint analysis and predictive modeling. Globally, pancreatitis prevalence and incidence rates have increased (AAPC prevalence=0.13, 95% CI: 0.11-0.16; AAPC incidence=0.30, 95% CI: 0.28-0.32), while mortality and DALYs rates have decreased (AAPC mortality=-1.30, 95% CI: -1.53, -1.07; AAPC DALYs=-1.21, 95% CI: -1.41, -1.01). Both genders showed similar trends. Children under 5 and adolescents 15-19 had higher mortality and DALYs rates. Low SDI regions experienced the greatest increase in ASIR. Eastern Europe exhibited high and rising ASIR, ASMR, and ASDR. Projections indicate continued rise in prevalence with declining mortality and DALYs. Pancreatitis burden in children and adolescents has surged globally, especially in lower SDI regions. These findings underscore the urgent need for targeted interventions and healthcare resources in affected areas.

Use of butorphanol as a local anaesthetic for pain management in calves undergoing umbilical hernia repair

The aim of the study was to compare the analgesic efficacy of butorphanol and lidocaine, alone or in combination, in calves undergoing surgical repair of umbilical hernia. The study was conducted in 60 calves of different breeds. Xylazine 0.3 mg/kg was administered intramuscularly to all animals in the study. The animals were then divided into three groups (n = 20) that received different treatments with lidocaine at 4.5 mg/kg and butorphanol at 0.02 mg/kg. The L group received lidocaine both by infiltration of the surgical planes and intraperitoneally, the B group received butorphanol both by infiltration of the surgical planes and intraperitoneally, and finally the LB group received lidocaine by infiltration of the surgical planes and butorphanol intraperitoneally. Heart and respiratory rates, haemoglobin oxygen saturation, non-invasive blood pressure and temperature were recorded during surgery. Response to the surgical stimulus was scored on a cumulative numerical scale that included percentage changes in HR, RR and SAP. Postoperative pain was assessed by three independent observers, blinded to treatment, using the UNESP-Botucatu Unidimensional Composite Pain Scale (UNESP-Botucatu UCPS-IV) for the assessment of postoperative pain in cattle. The course of physiological variables was appropriate for patients under anaesthesia. No subject required rescue intraoperative analgesia. In group L, 4 subjects at 40 m and 5 subjects at 50 m required postoperative rescue analgesia. Both butorphanol alone and the combination of butorphanol and lidocaine showed excellent intraoperative and postoperative scores. Furthermore, this combination did not cause any cardiopulmonary or other adverse effects. Based on the results of this study, both butorphanol alone and the co-administration of butorphanol and lidocaine administered locally proved to be safe and effective in providing adequate and long-lasting analgesia in calves, helping to reduce postoperative discomfort and maintaining adequate animal welfare.

Performance fatigability in adults with spinal muscular atrophy treated long-term with nusinersen.

Persons with spinal muscular atrophy (pwSMA) report progressive muscle weakness but also reduced endurance when performing repetitive tasks in daily life, referred to as "performance fatigability" (PF). Data regarding the effects of the new disease-modifying drugs on PF are scarce. Thus, our main objective was to examine PF in adult ambulatory pwSMA treated long-term with nusinersen. Six-minute walk test (6MWT) data from 14 adult pwSMA treated with nusinersen for up to 70 months were retrospectively analyzed to determine PF. Performance fatigability was defined as the percentage change in the distance covered between the last and first minute of the 6MWT. In addition, relationships between PF and other clinical features were assessed. Performance fatigability was found in 12/14 pwSMA (85.7%) prior to treatment. The mean distance walked in the sixth minute (71.1 m) was shorter than the distance covered in the first minute (81.8 m), corresponding to a mean PF of 13.1% (95% confidence interval (CI): 6.5-19.6, p = .0007). During treatment with nusinersen, there was a mean reduction in PF of 5.6% (95% CI: -10.0 to -1.3, p = .0148). We found no relationship between PF and fatigue as measured by the Fatigue Severity Scale. This study demonstrates the presence of PF as an independent component of motor impairment and as a potential therapeutic target in our cohort of adult ambulatory pwSMA. Furthermore, the observations in our cohort suggest that nusinersen may have a beneficial effect on PF.

Mortality Patterns of Esophageal Cancer in the United States: A 21-Year Retrospective Analysis.

Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first 5 years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. The mortality trends among adults with EC were analyzed using data from the CDC WONDER database. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joinpoint regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999 to 2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and nonmetropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared with states falling in the lower 10th percentile. Over the last 2 decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

Incorporating functional traits with habitat maps: patterns of diversity in coastal benthic assemblages

Benthic species assemblages are groups of species that co-occur on the seafloor. Linking assemblages to physical environmental features allows for understanding and predicting their spatial distribution. Species identity and abundance are commonly quantified using a taxonomic approach to assess benthic diversity, yet functional traits that describe the behavior, life history, and morphology of a species may be equally or more important. Here, we investigate the biodiversity of five benthic species assemblages in relation to their habitat and environmental conditions in an Ecologically and Biologically Significant Area (EBSA) along Canada’s east coast, using both a taxonomic approach and biological traits analysis. Random Forest regression was applied to map spatial patterns of functional and taxonomic diversity metrics, including richness, Shannon index, and Rao’s quadratic entropy. We evaluate discrepancies between related taxonomic and trait measures, and the community-weighted mean of trait data was calculated to characterize each assemblage. Taxonomic and functional richness – representing the number of species and the species community volume in the trait space, respectively – showed similar spatial patterns. However, when considering diversity, which also accounts for the relative abundance and differences among species or traits, these patterns diverged. Taxonomically different assemblages exhibited similar trait compositions for two assemblages, indicating potential trait equivalencies, while one assemblage exhibited traits potentially indicating sensitivity to human activity. The taxonomic and functional metrics of richness and diversity were low close to the coast, which could be indicative of disturbance. Consideration of functional metrics can support spatial planning and prioritization for management and conservation efforts by assessing the sensitivity of traits to different stressors.

A-115 Iron assay improvement: The need for thiourea addition in Ferene/Ferrozine reagent cartridge

Abstract Background Iron assay is often ordered along with ferritin, transferrin, and iron binding capacity in patients suspected of having iron deficiency anemia or iron overload. A ferene/Ferrozine chromogen-based iron assay is more common in College of American Pathology accredited laboratories across U.S. Recently, a product recall/field safety notice was issued by a major manufacturer for several lots of ferene based iron reagent due to unacceptable positive bias in patient iron results. However, the reason(s) underlying this positive bias was not provided. In this report, we investigated the possible causes for the recall of specific lots of iron assay reagents. Methods The performance of 2 lots of recalled iron test kits was compared against 2 good lots (Sentinel Diagnostics) on the Alinity c analyzer utilizing approved calibrator lots, quality control (QC) materials (Bio-Rad Laboratories), and excess/leftover de-identified patient samples. Spectral scan (in the visible wavelength) of good and recalled lots of reagents, R1 and R2 was performed on the Tecan microplate reader. Trace elements in R1 and R2 reagents were estimated with Quantitative Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Spiking experiments in calibrator, discarded patient samples, and reagents were undertaken to further elucidate the cause and prevention of positive bias seen with recalled reagent lots. Graphs and statistical analysis were generated using Graphpad prism 10.1. Results Iron levels in QC materials and de-identified patient samples (n=42) tested with 2 recalled lot of reagents on Alinity c analyzer showed a positive bias of 15-36% compared to unimpacted lots of reagents. Calibrator and blank absorbance of recalled lots was much higher than the unimpacted lots. Percentage change in the basal absorbance of recalled vs unimpacted R2 reagent measured from 500 to 600 nm in 25 nm increments and corrected to 700 nm ranged from 150 to 250%. No such changes were noted with both R1 reagents. Interestingly, ICP-MS heavy metal panel analysis revealed that R2 reagent of the recalled lots had unanticipated presence of Cu (∼22 υg/dL) and lead (7.5 υg/L), which was not present in R1 reagents. Increased concentrations of Cu spiking (100, 200, and 400 υγ/dL) in R2 reagent from recalled lots discernibly increased the Cal Factor values as well as patient iron results relative to unspiked reagent. Further, the presence of Cu over time deteriorated the accuracy of R2 reagent reflecting on very high rise in Cal Factor and patient iron values. Interestingly, TU addition to R2 reagent from unimpacted lot prevented the Cu-induced spurious rise in Cal Factor and iron measurements in the patient samples. Further, TU exhibited sustained preventive effect on Cu-induced iron measurement changes over time. Conclusions Based on our investigation, we conclude that copper contamination of R2 reagent is the possible cause for the positive bias in the recalled iron assay reagent lots. We recommend the addition of TU to Ferene containing R2 reagent pack as a simple and effective step to prevent Cu-induced false elevation in iron values.

Analysis of the global burden of cardiovascular diseases linked to exposure to ambient particulate matter pollution from 1990 to 2019

BackgroundThis research endeavors to scrutinize the temporal trends and global burden of cardiovascular diseases (CVDs) associated with ambient particulate matter (PM) pollution spanning from 1990 to 2019.MethodsAge-standardized death rates (ASDRs) and age-standardized disability-adjusted life years (DALYs) for CVDs, as well as their estimated annual percentage changes (EAPCs), were calculated using data from the Global Burden of Disease Study 2019 (GBD 2019).ResultsThe global ASDR and age-standardized DALYs due to CVDs associated with PM pollution increased from 1990 to 2019, with a higher increase in males. The burden was higher among middle-aged and older adults. The ASDR and DALYs increased in low-Socio-demographic Index (SDI), low–middle-SDI, and middle-SDI countries, while they decreased in high-SDI countries. The highest burden was observed in Central Asia, North Africa, the Middle East, East Asia, and South Asia. The highest burdens were reported in Iraq, Egypt, and Uzbekistan at the national level.ConclusionThe burden of CVDs linked to PM pollution has grown significantly from 1990 to 2019, with variations across regions and countries, highlighting the need for targeted prevention and pollution management strategies.

B-127 The Effect of Hemolysis on Potassium Measurement in a Community Setting: The Marching Error

Abstract Background Potassium is one of the most sensitive analytes to in-vitro hemolysis. To detect this error, modern clinical chemistry analyzers calculate the hemolysis index (HI) to estimate the degree of specimen hemolysis. Recently, Roche Diagnostics lowered the acceptable potassium HI limit from 100 to 20 and recommended laboratories avoid using specimens with an HI&amp;gt;20. The goal of this study was to determine a clinically acceptable HI cut-off for potassium at our community reference laboratory, relying on patient data from routine laboratory operation. Methods Plasma venous potassium, sodium, and HI test results from community patients measured on Roche cobas 8000 ISE and c701 modules between September 2022 to December 2023 were extracted from the Roche Infinity Middleware (n=1,101,897). Data was divided into groups based on HI which ranged from 0 to 300. The sample pool with the lowest level of hemolysis (HI≤10) was defined as the base group. Mean and standard deviation of potassium for each HI group was calculated and the difference in the mean between each group compared to the base group was calculated as both absolute and percent ΔK. Percent changes in critical values for both potassium and sodium as a function of hemolysis were calculated for each HI group. Measurement uncertainty (MU) for potassium was calculated using a top-down approach. Data were analyzed in Rstudio and Microsoft Excel. Results The vast majority of potassium specimens (83.8%) were stratified into the HI base group (HI ≤10) and 96.8 % had an HI ≤ 20, the cut-off recommended by Roche. The mean potassium level for each HI group increased as the degree of hemolysis in the specimens became more elevated. A MU-derived analytically significant shift of ΔK&amp;gt;0.1 mmol/L was observed for the bin HI 21-30. Depending on the employed total allowable error limit, clinically significant shifts in mean potassium levels were observed at HI bin 41-50 (RCPA: ΔK&amp;gt;0.2 mmol/L) or HI bin 101-150 (EFLM-derived reference change value: ΔK&amp;gt;10.1% and CLIA: ΔK&amp;gt;0.5mmol/L. The shift in patient potassium values seen as HI increased led to a change in critical results reporting frequencies. In the base group (HI≤10), 0.06% and 0.07% of results had low (&amp;lt;2.6 mmol/L) or high (&amp;gt;6.2 mmol/L) critical potassium values, respectively. When HI was 101-300, 0.00 and 15.7% of results had low or high critical potassium values. A similar comparison performed with sodium did not show the same shift in reported critical values. Linear regression of ΔK plotted vs HI produced the equation ΔK=0.0051xHI, validating the equation of Martinez-Morillo and Alvarez published previously using paired hemolyzed/non-hemolyzed potassium laboratory data. Conclusions In community patients, in-vitro hemolysis produced analytically significant errors at an HI of 20. Clinically significant errors occurred between an HI of 40-100. Past HI 100, mean ΔKs of 0.5-1.20 mmol/L were seen in our population. This shift in patient values as a function of hemolysis led to a change in critical result reporting, suggesting the generation of both factious critically high potassium results and the masking of critically low potassium results in our patient population.

B-357 Siemens CA 72-4: an assay for measurement of Tumor Associated Glycoprotein (TAG) 72

Abstract Background The tumor associated glycoprotein (TAG) 72, also known as CA 72-4 is a mucin protein of high molecular weight. CA 72-4 is found on the surface of many cancer cells, including stomach (gastric), ovary, breast, colon and pancreatic cells. CA 72-4 is currently one of the primary markers for the diagnosis of gastric cancer and monitoring the course and efficacy of gastric cancer. In ovarian cancer, it has a higher sensitivity for mucin- type ovarian cancer, and its combination with CA125 for detection can significantly improve the clinical sensitivity. In colorectal cancer, CA 72-4 combined with CEA detection was also found to significantly improve the sensitivity of the initial diagnosis. An assay for CA 72-4 on Siemens Atellica IM (Siemens CA 72-4) is being developed and analytical performance is being presented. Methods The Siemens CA 72-4 assay (in development) is a one-step chemiluminescent microparticle immunoassay (CMIA) for the quantitative determination of CA 72-4 in human serum and plasma. The specimen is incubated with paramagnetic microparticles coated with the monoclonal antibody (mAb) B72.3 and acridinium-labeled mAb CC49 conjugate on the Siemens Atellica IM® System. After incubation and washing, Acid and Base reagents are added. The resulting relative light units (RLUs) are directly proportional to the amount of CA 72-4 in the sample allowing for the quantitative determination of CA 72-4 in the specimen. Results The following performance were determined using 3 unique lots of reagents and calibrators with the calibration range for the assay being 0.00 to 200.00 U/mL. The limit of blank (LoB), limit of detection (LoD), and limit of quantitation at 20% CV (LoQ) were determined and met the goal of ≤ 1.00 U/mL. Linearity according to CLSI EP06 Ed2 was demonstrated for a range of 1.00 through 200.00 U/mL. A Precision study of 2 controls and 5 panels spanning the range of the assay demonstrated a total %CV ≤ 6% for samples ≥ 5.00 U/mL and ≤ 0.25 SD for samples &amp;lt;5.00 U/mL. In the sample tube type study, a matrix comparison of 23 matched serum and plasma samples were evaluated. Passing-Bablock slopes of &amp;lt; 8% and r &amp;gt; 0.99 were observed when evaluating samples within the measurement range for plasma (LiHep, LiHep separator, K2EDTA and K3EDTA) tubes and serum separator tubes (SST) compared to the Red Top serum samples. Five endogenous substances were evaluated for interference in the CA 72-4 assay. The average percent difference between test and control samples for all endogenous interferents was &amp;lt; 10%. Percent difference in the presence of 28 potentially interfering drugs was ≤ 4.0%. Conclusions The Siemens CA 72-4 assay currently in development is a sensitive and precise assay for the quantitative determination of CA 72-4 in human serum and plasma.