Risk Index Research Articles

A Research Note on Community Resilience Estimates: New U.S. Census Bureau Data With an Application to Excess Deaths From COVID-19.

In this research note, we describe the results of the first validation study of the U.S. Census Bureau's new Community Resilience Estimates (CRE), which uses Census microdata to develop a tract-level vulnerability index for the United States. By employing administrative microdata to link Social Security Administration mortality records to CRE, we show that CRE quartiles provide more stable predictions of COVID-19 excess deaths than single demographic categorizations such as race or age, as well as other vulnerability measures including the U.S. Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) and the Federal Emergency Management Agency's National Risk Index (NRI). We also use machine learning techniques to show that CRE provides more predictive power of COVID-19 excess deaths than standard socioeconomic predictors of vulnerability such as poverty and unemployment, as well as SVI and NRI. We find that a 10-percentage-point increase in a key CRE risk measure is associated with one additional death per neighborhood during the initial outbreak of COVID-19 in the United States. We conclude that, compared with alternative measures, CRE provides a more accurate predictor of community vulnerability to a disaster such as a pandemic.

Heavy metal spatial distribution, source analysis, and ecological risks in the central hilly area of Hainan Island, China: results from a high-density soil survey.

The presence of heavy metals in soil has gained considerable attention due to their potential risks to ecosystems and human health. In this study, a thorough soil investigation was performed in the hilly region of central Hainan, which was formerly regarded as an area with the highest ecological environmental quality. A total of 7094 soil samples were systematically collected with high density over a large area. Simultaneously, a detailed investigation was conducted on the surrounding environment of each sampling point, including environmental factors such as soil, land use and crop types. The soil samples were analysed for heavy metals, pH, organic matter, and other parameters. The soil heavy metal pollution level, ecological risk and health risk were evaluated using the geo-accumulation index and the potential ecological risk index. The findings showed that the average contents of the heavy metals As, Cd, Cr, Cu, Hg, Ni, Pb and Zn in the soil were 1.68, 0.042, 24.2, 6.49, 0.0319, 7.06, 29.6 and 49.8mg·kg-1 respectively. Except for Hg, the mean values of the other heavy metals were either lower than or similar to the background values of Hainan. Also, only a few localised areas showed contamination by heavy metals. The primary sources of heavy metals, identified by a positive matrix factorisation model, could be categorised into four types: natural sources related to the soil formation process from acidic intrusive rocks (such as granite); natural sources primarily influenced by atmospheric deposition; anthropogenic sources associated with agricultural activities; and natural sources related to the soil formation process from middle-mafic intrusive rocks and black shales. The correlation analysis and variance analysis findings suggested that the content of heavy metals in the soil was primarily associated with the parent rock. The study area generally had low heavy metal levels and was not significantly polluted. However, agricultural activities still affected the enrichment of heavy metals. Therefore, it is imperative to remain vigilant about the ecological risks linked to soil heavy metals while continuing land development and expanding agricultural activities in the future. These findings indicate that conducting high-density soil surveys can enhance our understanding of regional soil heavy metals and enable reliable recommendations for agricultural planning. Whether in areas with low pollution risk or potential pollution risk, it is recommended that high-density soil surveys be conducted provide scientific guidance for further agricultural development.

Predictive Value of Modified Frailty Index, Sarcopenia, Prognostic Nutritional Index, and Geriatric Nutritional Risk Index for Postoperative Complications in Oblique Lumbar Interbody Fusion Over 60 Years

ObjectiveElderly patients undergoing spinal surgery are at an increased risk of morbidity and mortality. Evaluating frailty and preoperative status is crucial for predicting postoperative outcomes. This study aimed to assess the predictive value of the modified Frailty Index (mFI), sarcopenia, Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI) in determining postoperative complications in patients undergoing oblique lumbar interbody fusion (OLIF) over 60 years. MethodsPreoperative risk factors were assessed using 11 variables, including mFI, PNI, GNRI. Complication rates were compared among nonfrail (mFI = 0; n = 50), prefrail (mFI = 0.09–0.18; n = 144), and frail (mFI ≥0.27; n = 80) patients. Demographic and perioperative variables were compared between the complication and noncomplication groups. The incidence of complications was the primary outcome measure. ResultsComplications occurred in 36 of 274 patients (13.1%). The frail group exhibited a significantly higher incidence of pneumonia than the nonfrail and prefrail groups. The complication group displayed significant differences in several variables, including age, fusion level, albumin level, lymphocyte count, platelet count, creatinine level, and estimated blood loss. Moreover, mFI, PNI, and GNRI differed significantly between the complication and noncomplication groups. ConclusionMFI, PNI, and GNRI can be useful for predicting postoperative morbidity and mortality in patients undergoing OLIF. These comprehensive assessment methods enable the identification of high-risk patients and the formulation of tailored strategies to enhance postoperative outcomes. Integrating mFI, PNI, and GNRI into the preoperative evaluation process can help healthcare providers proactively manage high-risk patients, thus improving the overall quality of care for elderly individuals undergoing OLIF.

Changes in characteristics and risk of freshwater microplastics under global warming

Microplastics present a significant threat to freshwater ecosystems. However, the impact of global warming on their characteristics and associated risks remains uncertain. This study collected 2793 sample sites from literature and datasets to create a new risk assessment and rank methodology, known as the Multi-characteristics Potential Ecological Risk Index (MPERI), which incorporates various microplastic characteristics, such as concentration, size distribution, color, shape, and polymer diversity. Using regression random forest models (RRF), this study predicted that a 10 °C increase would raise microplastic concentration from 12,465.34 ± 68,603.87 to 13,387.17 ± 60,692.96 particles/m3. The percentage of small-size microplastics initially decreased (from 69.10 % to 68.72 %) and then increased (from 68.72 % to 68.78 %), while the diversity of color, shape, and polymer decreased by 0.29 %, 3.24 %, and 0.17 %, respectively. Furthermore, global warming could increase the rank of microplastic risks from high (405.25 ± 528.9) to dangerous (535.37 ± 582.03) based on the MPERI method. Most countries would experience an increase in risk values, with Indonesia and Vietnam transitioning from low to medium risk, and China and Malaysia transitioning from high to dangerous risk. The feature importance assessment of the RRF model indicated that concentration was the most influential variable in determining the change in risk values. While other microplastic characteristics had a lesser impact compared to concentration, they still influenced the risk ranking. This study highlights the role of global warming in shaping microplastic risks.

Non-negligible environmental risks of typical hazardous trace elements in wastes from Chinese coal-fired industrial boilers

Coal-fired industrial boilers (CFIBs) that provide heat for industrial production operate to produce large quantities of wastes containing hazardous trace elements (HTEs), threatening the quality of the environment. Based on the established facility-level material flow inventory of five typical HTEs (Hg, As, Cd, Cr, and Pb) of Chinese CFIBs in 2020, we explored the enrichment characteristics and environmental risks of HTEs in wastes at the regional scale from the perspective of substance flow and enrichment levels. Results showed that the shares of HTEs entering the waste stream were 2.2–16.8 % higher in the focus regions of continuous improvement of air quality compared to the non-focus regions, explained by the higher synergistic control efficiencies of their air pollution control facilities (ACPFs), at 86.6–90.4 % (Hg), 98.6–99.1 % (As), 95.1–95.9 % (Cd), 93.2–94.8 % (Cr), and 97.1–98.0 % (Pb), respectively. In addition, the national averages of HTEs in slag, fly ash, and flue gas desulphurisation (FGD) were simulated to be 0.15–0.87 g/t, 3.25–18.44 g/t, 0.30–0.96 g/t, 19.76–70.11 g/t, and 15.85–73.74 for Hg, As, Cd, Cr, and Pb, respectively. Nationally, the integrated environmental risks of the five HTEs in slag, fly ash, and FGD residue exhibited Considerable, Very High, and Very High level of environmental risk, with the cumulative environmental risk indexes of 171, 317, and 281, respectively. Hg and Cd were the major contributors to the environmental risks of slag, fly ash, and FGD residue, with environmental risk contributions ranging from 23.8 to 82.3 % and 16.0 to 66.1 %, respectively. Results can provide data support for modelling the environmental release of HTEs from wastes and formulating control strategies for environmental management agencies.

47MO The risk index of early relapse defined by MiROvaR, a miRNA-based classifier, is a potential predictive marker for bevacizumab benefit: A MITO-MANGO-ENGOT study

47MO The risk index of early relapse defined by MiROvaR, a miRNA-based classifier, is a potential predictive marker for bevacizumab benefit: A MITO-MANGO-ENGOT study

A risk-based approach to the analysis of potential climate change effects on fish communities associated to Posidonia oceanica in the Mediterranean

The Mediterranean is recognized as a climate change hotspot, with ongoing warming anticipated to impact its habitats and their associated fish fauna. Among these habitats, the seagrass Posidonia oceanica stands out as a foundational species, critical for the stability of coastal fish communities. However, our understanding of climate change consequences on P. oceanica associated fish fauna to date remains limited in part due to a lack of long-term data. This study aimed to highlight potential climate change risks to fish species associated with Posidonia, integrating data on species' thermal envelopes with their habitat and depth preferences into a climate change risk index. Specifically, 9 species, including three pipefish and several wrasse species of the genus Symphodus, emerged as being at higher potential risk from climatic change. A historical time series from Palma Bay (Balearic Islands, Spain), spanning 45 years and providing clear evidence of warming, was employed to evaluate trends in species abundance and occurrence in relation to their relative climate risk score. While certain high-risk species like Symphodus cinereus and Diplodus annularis showed an increase in abundance over time, others, such as the pipefish Syngnathus acus, Syngnathus typhle and Nerophis maculatus experienced declines. The absence of observed declines in some high-risk species could be attributed to several factors, such as acclimation, adaptation, or unmet response thresholds. However, this does not rule out the potential for future changes in these species. Factors such as increased nutrient influx due to growing human populations and changes in fishing regulations may also have contributed to the observed trends. These findings underscore the intricate interplay of environmental and anthropogenic factors and accentuate the pressing need for sustained, long-term data acquisition to fathom the implications of climate change on this highly important marine ecosystem.

Heatwave Frequency and Disability Status: Thermal Inequities in the U.S. South

Heatwave Frequency and Disability Status: Thermal Inequities in the U.S. South

Calculation of Risk Indicators for Radioactivity in the Soil of Region Hammam Al-Alil, Nineveh Governorate, Iraq

Calculation of Risk Indicators for Radioactivity in the Soil of Region Hammam Al-Alil, Nineveh Governorate, Iraq

Association between posterior occlusal support and tooth loss in a population-based cohort: The OHSAKA study

ObjectivesThis study aimed to assess the association between posterior occlusal support (POS) and the risk of tooth loss in older adults aged ≥75 years. MethodsThis longitudinal study analyzed 94,422 participants who participated in multiple dental check-ups provided as part of the public healthcare services in Osaka, Japan, from 2018 to 2022. The participants were categorized into nine groups (A1–3, B1–4, and C1 and C2) according to their POS status using the Eichner index at baseline. The dental charts were compared between the initial and final assessments to assess tooth loss. Logistic regression analysis was used to examine the association between POS status and tooth loss, adjusted for several covariates, including age, sex, body mass index, periodontal status, oral hygiene, history of diabetes, history of hypertension, attendance at the annual dental check-up, and observational period. Furthermore, stratified logistic regression analyses were conducted using anterior or posterior tooth loss. ResultsAfter controlling for confounders, POS status was associated with tooth loss. The odds ratios (ORs) with A1 as the reference were 1.74 in A2, 2.55 in A3, 3.40 in B1, 4.74 in B2, 5.79 in B3, 6.00 in B4, 4.44 in C1, and 3.00 in C2, respectively. The ORs for anterior tooth loss were higher than those for posterior tooth loss, with the highest OR observed in B4 (21.4). ConclusionsThis large population-based cohort study showed that a decreased POS was a risk indicator for tooth loss; furthermore, the risk increased even further in the anterior teeth region.

OP15 Correlation between Quality of Care and Financial Risk Indicators in Public Hospitals

OP15 Correlation between Quality of Care and Financial Risk Indicators in Public Hospitals

The Inflammation-Fibrosis Combined Index: A Novel Marker for Predicting Left Ventricular Reverse Remodeling and Prognosis in Patients with HFrEF.

Inflammation and cardiac fibrosis are important pathogenic drivers of heart failure. The fibrosis-4 index (FIB-4) is associated with a higher degree of fibrosis. The systemic immune inflammation index (SII) is associated with a higher degree of systemic inflammation status. Previous studies have shown that they are associated with a poor prognosis for cardiovascular disease. We sought to investigate the value of FIB-4 combined with the SII as a novel inflammation-fibrosis combined index (IFCI) in predicting left ventricular reverse remodeling (LVRR) and prognosis among reduced ejection fraction heart failure (HFrEF) patients. A total of 895 patients with HFrEF were continuously recruited. Receiver operating characteristic curves were drawn to assess the abilities of inflammation-fibrosis indicators to predict LVRR. Multivariable Cox regression analysis was used to examine independent predictors of composite cardiac events and all-cause death. After six months of follow-up, 344 (38.4%) patients experienced LVRR. The IFCI had the largest area under the curve (0.835, P < 0.001). In multivariate-adjusted logistic regression analyses, FIB-4, SII, and IFCI were predictive of LVRR (P value < 0.05). The IFCI was associated with a 3.686-fold higher risk of non-LVRR (odds ratio [OR] = 3.686, P < 0.001). Moreover, an increased IFCI predicted a poor prognosis in HFrEF patients. The highest risk of composite cardiac events (hazard ratio [HR] = 2.716, P < 0.001) was observed in the top IFCI-tertile group, and similar results were found regarding independent risk indicators of all-cause death. In summary, this study indicated that increased IFCI at admission offers good predictability regarding non-LVRR and predicts the risk of all-cause mortality or composite cardiovascular events due to HFrEF patients and could be used as a novel marker.

Metals profile of milled shrimps and the potential risk associated with their consumption

The presence of metals in milled shrimps sold on some major markets in Kumasi were investigated to ascertain their levels and the potential health risk they may pose to humans when ingested, due to the level of pollution in the marine environment where these shrimps are obtained from. The samples, which comprised of 30 composites, were analysed using x-ray florescence spectrometry and found to contain Co, Cr, Cu, Fe, K, Mo, Ca, Zn, As, Sr, and Zr with average concentrations of 4.09 mg kg− 1, 5.17 mg kg− 1, 25.14 mg kg− 1, 351.47 mg kg− 1, 9050.74 mg kg− 1, 4.08 mg kg− 1, 21984.48 mg kg− 1, 696.89 mg kg− 1, 8.99 mg kg− 1, 328.54 mg kg− 1, and 9.86 mg kg− 1 respectively. Non-carcinogenic risk indicators analysed suggested a likelihood of health hazard when the milled shrimps are ingested, particularly concerning is the levels of arsenic determined. The arsenic may, however, be in organic form which will make it less of a concern. The levels of the metals could not be linked statistically to the milling process after comparing them to procured controls, which may suggest that these metals may have been picked up in the aquatic environment and/or prior to milling. There is a need, therefore, for action to reduce pollution and remediate the aquatic environment.

Assessment of Rural Flood Risk and Factors Influencing Household Flood Risk Perception in the Haut-Bassins Region of Burkina Faso, West Africa

In the past two decades, several floods have affected people and their properties in Burkina Faso, with unprecedented flooding occurring in Ouagadougou in September 2009. So far, most studies have focused on Ouagadougou and surrounding localities and have paid little attention to other flood-prone regions in Burkina Faso. Consequently, there is a data and knowledge gap regarding flood risk in the Haut-Bassins region, which in turn hinders the development of mitigation strategies and risk reduction measures in affected communities. This study demonstrates how data collected at the household level can be used to understand flood risk and its components at the village level in this data-scarce region. Using an indicator-based method, we analyzed both flood risk and flood risk perception at the village level. Moreover, we determined the factors influencing flood risk perception at the household level using an ordered logit model. We found that 12 out of the 14 villages in our sample group had experienced high levels of flood risk. The management of runoff from the nearest urban areas as well as poorly designed civil engineering infrastructures, such as roads, were highlighted by households as significant factors that increased their vulnerability. Additionally, we found that the perceived flood risk consistently exceeds the estimated flood risk, with an insignificant positive correlation between both risk indices. Regression results indicate that flood risk perception is mainly influenced by informational and behavioral factors of households. The findings of this study can provide valuable information to municipal and regional authorities involved in disaster risk management within the study area. Moreover, our/this method is transferable to other data-scarce regions.

The impact of intimate partner violence on PrEP adherence among U.S. Cisgender women at risk for HIV

BackgroundCisgender women account for 1 in 5 new HIV infections in the United States, yet remain under-engaged in HIV prevention. Women experiencing violence face risk for HIV due to biological and behavioral mechanisms, and barriers to prevention, such as challenges to Pre-Exposure Prophylaxis for HIV Prevention (PrEP) adherence. In this analysis, we aim to characterize intimate partner violence (IPV) among cisgender heterosexual women enrolled in a PrEP demonstration project and assess the associations with PrEP adherence.MethodsAdherence Enhancement Guided by Individualized Texting and Drug Levels (AEGiS) was a 48-week single-arm open-label study of PrEP adherence in HIV-negative cisgender women in Southern California (N = 130) offered daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). From 6/2016 to 10/2018, women completed a survey reporting HIV risk behavior and experiences of any IPV (past 90-days) and IPV sub-types (past-year, lifetime) and biological testing for HIV/STIs at baseline, and concentrations of tenofovir-diphosphate (TFV-DP) in dried blood spots at weeks 4, 12, 24, 36, and 48. Outcomes were TFV-DP concentrations consistent with ≥ 4 or ≥ 6 doses/week at one or multiple visits. Multivariable logistic regression models were conducted to examine associations.ResultsPast-90-day IPV was reported by 34.4% of participants, and past-year and lifetime subtypes reported by 11.5-41.5%, and 21.5-52.3%, respectively. Women who engaged in sex work and Black women were significantly more likely to report IPV than others. Lifetime physical IPV was negatively associated with adherence at ≥ 4 doses/week at ≥ 3 of 5 visits, while other relationships with any IPV and IPV sub-types were variable.ConclusionIPV is an indication for PrEP and important indicator of HIV risk; our findings suggest that physical IPV may also negatively impact long-term PrEP adherence.Clinical Trials RegistrationNCT02584140 (ClinicalTrials.gov), registered 15/10/2015.

Relationship between Simulated Fire Suppression Activities and Acute Cardiac and Respiratory Events in Firefighters.

Cardiac deaths account for the largest share of on-duty firefighter deaths. To help ensure duty fitness and minimize injury risk, many fire departments require the passing of an annual physical ability test, consisting of a battery of simulated fire suppression activities (sFSAs). The purpose of the study was to determine the relationship of sFSA performance to acute cardiac and respiratory events (ACREs) and the effect that estimated VO2max has on sFSA performance. The study was retrospective. As part of an annual physical ability test, five timed sFSAs were performed, summed for a composite time, and categorized into three performance levels (fast, moderate, and slow). Estimated VO2max was determined using the Forestry Step Test. A significant (p = 0.023) linear trend was observed with higher sFSA performance times being associated with a higher proportion of firefighters going on to suffer an ACRE. The estimated VO2max was significantly (p < 0.001) higher in the fast group compared to the slow group. There was not a significant (p = 0.70) difference in estimated VO2max between the moderate and slow groups. Estimated VO2max performance and sFSA performance were significantly correlated, with rs(488) = -0.272 and p < 0.001. Poorer sFSA performance was found to be associated with a higher proportion of ACREs. The results suggest that sFSA performance may be a valid indicator of ACRE injury risk and aerobic capacity.

Alzheimer's disease risk associated with changes in Epstein-Barr virus nuclear antigen 1-specific epitope targeting antibody levels

BackgroundAlzheimer's disease (AD) is a neurodegenerative disorder influenced by age, sex, genetic factors, immune alterations, and infections. Multiple lines of evidence suggest that changes in antibody response are linked to AD pathology. MethodsTo elucidate the mechanisms underlying AD development, we investigated antibodies that target autoimmune epitopes using high-resolution epitope microarrays. Our study compared two groups: individuals with AD (n = 19) and non-demented (ND) controls (n = 19). To validate the results, we measured antibody levels in plasma samples from AD patients (n = 96), mild cognitive impairment (MCI; n = 91), and ND controls (n = 97). To further explore the invlovement of EBV, we performed epitope masking immunofluorescence microscopy analysis and tests to induce lytic replication using the B95–8 cell line. ResultsIn this study, we analyzed high-resolution epitope-specific serum antibody levels in AD, revealing significant disparities in antibodies targeting multiple epitopes between the AD and control groups. Particularly noteworthy was the significant down-regulation of antibody (anti-DG#29) targeting an epitope of Epstein-Barr virus nuclear antigen 1 (EBNA1). This down-regulation increased AD risk in female patients (odds ratio up to 6.6), but not in male patients. Our investigation further revealed that the down-regulation of the antibody (anti-DG#29) is associated with EBV reactivation in AD, as indicated by the analysis of EBV VCA IgG or IgM levels. Additionally, our data demonstrated that the epitope region on EBNA1 for the antibody is hidden during the EBV lytic reactivation of B95–8 cells. ConclusionOur findings suggest a potential relationship of EBV in the development of AD in female. Moreover, we propose that antibodies targeting the epitope (DG#29) of EBNA1 could serve as valuable indicators of AD risk in female.

Money laundering and terrorist financing risks and democratic governance: a global correlational analysis

Purpose This paper aims to examine the association between money laundering (ML)/terrorist financing (TF) risks (hereafter, money laundering risks) and democratic governance across 117 countries. Design/methodology/approach A cross-sectional design was used to examine the association between ML risks and democratic governance by a quantitative approach. The findings are based on annual ratings of 117 countries on ML/TF risks and democracy while controlling for criminality and peace. The data was compiled from the Basel Anti-Money Laundering/Countering Financing Terrorism Risks Index, the Economic Intelligence Unit (Democracy Index), the Global Initiative against Transnational Organized Crimes (Criminality Index) and the Institute for Economics and Peace Index for 2020. Findings A multiple linear regression model found a statistically significant negative association between democratic governance and ML risks (B = −0.354, t = −7.454, p = &lt;0.001) and a significant positive association between criminality and ML risks (B = 0.242, t = 2.692, p = 0.008). Research limitations/implications A cross-sectional design cannot determine causal inferences and generalization (Levin, 2006). The study only used a year to examine the hypothesis of a negative correlation between ML risks and democratic governance, thus making generalization difficult. Originality/value Extant literature examined ML, terrorism and AML diversely. There was a need to estimate the association between ML risks and democratic governance, especially globally, during a global crisis like COVID-19, when democratic principles, such as the rule of law, transparency and accountability, are challenged. Many personnel were laid off, thus limiting supervision for ML and TF. This study presents evidence of this association.

Real-Life Achievements of MiniMed 780G Advanced Closed-Loop System in Youth with Type 1 Diabetes: AWeSoMe Study Group Multicenter Prospective Trial.

Background: We assessed real-life glycemic outcomes and predictors of composite measures of optimal glycemic control in children and adolescents with type 1 diabetes (T1D) during their initial 12 months of the MiniMed™ 780G use. Methods: This prospective observational multicenter study collected demographic, clinical, and 2-week 780G system data at five time points. Optimal glycemic control was defined as a composite glycemic control (CGC) score requiring the attainment of four recommended continuous glucose monitoring (CGM) targets, as well as the glycemia risk index (GRI) of hypoglycemia and hyperglycemia and composite CGM index (COGI). Outcome measures included longitudinal changes in multiple glycemic parameters and CGC, GRI, and COGI scores, as well as predictors of these optimal measures. Results: The cohort included 93 children, 43% girls, with a median age of 15.1 years (interquartile range [IQR] 12.9,17.0). A longitudinal analysis adjusted for age and socioeconomic index yielded a significant improvement in glycemic control for the entire cohort (ptime < 0.001) after the transition to 780G. The mean hemoglobin A1c (HbA1c) (SE) was 8.65% (0.12) at baseline and dropped by >1% after 1 year to 7.54% (0.14) (ptime < 0.001). Optimal glycemic control measures improved at 12 months post 780G; CGC improved by 5.6-fold (P < 0.001) and was attained by 24% of the participants, the GRI score improved by 10-fold (P = 0.009) and was achieved by 10% of them, and the COGI improved by 7.6-fold (P < 0.001) and was attained by 20% of them. Lower baseline HbA1c levels and increased adherence to Advanced Hybrid Closed-Loop (AHCL) usage were predictors of achieving optimal glycemic control. Conclusions: The AHCL 780G system enhances glycemic control in children and adolescents with T1D, demonstrating improvements in HbA1c and CGM metrics, albeit most participants did not achieve optimal glycemic control. This highlights yet ongoing challenges in diabetes management, emphasizing the need for continued proactive efforts on the part of health care professionals, youth, and caregivers.

Environmental indicators of lake ecosystem health in Aotearoa New Zealand: current state and trends

Assessments of lake ecosystem health, based on indicators of physical–chemical water quality, ecological conditions, and human health risks, are needed to apprise the public and facilitate lake management. While unrefereed lake water quality reports exist, this is the first peer-reviewed study to report data processing and analysis methods and results for current state and recent trends in multiple environmental indicators in monitored lakes across Aotearoa New Zealand. Lake grading based on national criteria indicated that many lakes are failing to achieve statutory bottom lines for phytoplankton chlorophyll a, total nitrogen, and total phosphorus concentrations. In contrast, most monitored lakes had high grades for two human health risk indicators, E. coli and cyanobacteria concentrations, and for potential toxicity of ammonia for biological communities. We included 166 lakes and considered indicator state and trends for two lake classifications based on geomorphology and land cover. Elevated scores for an indicator of trophic state (the trophic level index; TLI) in most shoreline, riverine, peat, landslide, dam, and aeolian lakes indicated eutrophic conditions or worse. Lower TLI scores were indicative of oligotrophic conditions in most glacial lakes. Nutrient, E. coli and suspended sediment concentrations and TLI scores were positively correlated, and Secchi depths negatively correlated, with high-intensity agricultural land cover. Ten-year trend analyses indicated that lakes with increasing Secchi disk depth, chlorophyll a, dissolved reactive phosphorus, E. coli, ammoniacal nitrogen, TLI, total nitrogen, and total suspended solids trends outnumbered those with decreasing trends. Twenty-year trend analyses indicated that the numbers of lakes with increasing and decreasing trends in most of the indicators we assessed were comparable, but lakes with increasing 20-year trends in total nitrogen outnumbered those with decreasing trends, and lakes with decreasing 20-year trends in ammoniacal nitrogen, dissolved reactive phosphorus, total phosphorus, and nitrate nitrogen outnumbered those with increasing trends. This study presents clear data processing steps and trend analysis methods as applied to a nationwide dataset for Aotearoa New Zealand, while acknowledging data limitations. For example, the choice of trend periods is challenging and can greatly affect conclusions. The results of this empirical study and the collective results of preceding studies of lake ecosystem health indicate that eutrophication poses a threat to the ecological health of many if not most lakes in Aotearoa New Zealand. Recommendations include monitoring network expansion especially for the indicators bottom dissolved oxygen and cyanobacteria (toxic and total cyanobacteria biovolumes) and judicious selection of trend periods in lake-specific trend analyses to determine causes for increasing or decreasing trends in environmental indicators.