Large Decrease Research Articles

Functional recycling of grain boundary diffusion processed Nd-Fe-B sintered magnets

Sintered Nd-Fe-B magnets industrially produced employing the grain boundary diffusion process (GBD) were recycled by the so-called functional or short-loop recycling approach, based on hydrogen decrepitation (HD). Microstructural and magnetic differences between the original and the recycled materials were analyzed. The functional recycling of GBD magnets leads to the dissolution of the core (heavy rare earth lean) - shell (heavy rare earth rich) structure through the different heat treatment steps which include hydrogen decrepitation, sintering, and annealing. The recycled magnets show similar rectangular demagnetization curves with squareness of 96 %, and only a slightly decreased remanence of 5 % to 1.31 T, but a larger decrease in coercivity of 21 % to 1703 kA/m. A new GBD step using 1.5 wt.% Tb with a pure Tb-foil as diffusion source leads again to the formation of a core-shell structure with 0.5 µm thick Tb-shells which is similar to the microstructure of the original magnets prior to recycling. The coercivity of the recycled magnets is increased by 35 % from 1315 kA/m to 1780 kA/m at 50 °C and shows similar magnetic values as the original industrial magnets at 150 °C and 200 °C, respectively. The temperature coefficients for the remanence, α, and for the coercivity, β, can also be fully restored and even exceed the original values which leads to an improved temperature stability of the recycled magnets compared to the original magnets.

Seasonality and Predictability of Hydrometeorological and Water Chemistry Indicators in Three Coastal Forested Watersheds

Forests are recognized for sustaining good water chemistry within landscapes. This study focuses on the water chemistry parameters and their hydrological predictability and seasonality (as a component of predictability) in watersheds of varying scales, with and without human (forest management) activities on them, using Colwell indicators for data collected during 2011–2019. The research was conducted in three forested watersheds located at the US Forest Service Santee Experimental Forest in South Carolina USA. The analysis revealed statistically significant (α = 0.05) differences between seasons for stream flow, water table elevation (WTE), and all water chemistry indicators in the examined watersheds for the post-Hurricane Joaquin period (2015–2019), compared to the 2011–2014 period. WTE and flow were identified as having the greatest influence on nitrogen concentrations. During extreme precipitations events, such as hurricanes or tropical storms, increases in WTE and flow led to a decrease in the concentrations of total dissolved nitrogen (TDN), NH4-N, and NO3-N+NO2-N, likely due to dilution. Colwell indicators demonstrated higher predictability (P) for most hydrologic and water chemistry indicators in the 2011–2014 period compared to 2015–2019, indicating an increase in the seasonality component compared to constancy (C), with a larger decrease in C/P for 2015–2019 compared to 2011–2014. The analysis further highlighted the influence of extreme hydrometeorological events on the changing predictability of hydrology and water chemistry indicators in forested streams. The results demonstrate the influence of hurricanes on hydrological behavior in forested watersheds and, thus, the seasonality and predictability of water chemistry variables within and emanating out of the watershed, potentially influencing the downstream ecosystem. The findings of this study can inform forest watershed management in response to natural or anthropogenic disturbances.

Strategi Pemerintah Daerah Kabupaten Bintan dalam Mengurangi Angka Pengangguran di Kabupaten Bintan

Bintan Regency is a Regency with the largest decrease in the open unemployment rate for the 2022-2023 period in the Riau Islands. This study aims to determine the strategy of the Bintan Regency Regional Government in reducing unemployment in Bintan Regency. The research method used is qualitative descriptive research with interview and documentation data collection techniques. The results of this study indicate that the Bintan Regency Manpower Office has mostly implemented its strategy well from the organizational strategy already having good strategies and policies. The program strategy has a positive impact on the workforce in improving skills and prioritizing the placement of local workers. The resource support strategy is adequate both in terms of human resources, finance, technology and infrastructure. Institutional strategy, responsible for performance targets and exercising its authority in reducing unemployment.

Life-years lost attributable to air, water and earth pollution in Asia and Pacific countries, 2000–2019

ABSTRACT Environmental risk factors are a growing global concern. This study quantifies the life-years lost (LYL) attributable to different types of pollution in Asia and Pacific countries (APAC) between 2000 and 2019. Data were obtained from the Institute for Health Metrics and Evaluation. Results indicate that people in Southern Asia lost the highest number of years due to all types of pollution among the APAC subregions. Eastern Asia, Oceania and Western Asia had the lowest life-years lost due to water, earth and air pollution, respectively. The number of years lost due to air and water pollution decreased during the studied period, while those due to earth pollution increased in several countries. Eastern, Central, and South-Eastern Asia showed considerable declines in LYL due to air pollution, while Oceania and Southern Asia experienced slower declines. Focusing on LYL from earth pollution, Oceania saw the largest decrease, whereas Southern Asia experienced an increase. Overall, the pace of decline in LYL attributed to the different pollutants showed similar trends of decline in most countries. Further public health research is needed to better understand the effects of different pollutants on populations, particularly in the most affected areas, and to guide future interventions.

Insights on Arc Magmatic Systems Drawn from Natural Melt Inclusions and Crystallization Experiments at PH2O =800 MPa under Oxidizing Conditions

Abstract Whole rock compositions at Buldir Volcano, western Aleutian arc, record a strong, continuous trend of iron depletion with decreasing MgO, classically interpreted as a calc-alkaline liquid line of descent. In contrast, olivine-hosted melt inclusions have higher total iron (FeO*) than whole rocks and show little change in FeO* with decreasing MgO. To investigate this discrepancy and determine the conditions required for strong iron depletion, we conducted oxygen fugacity (ƒO2) buffered, water-saturated crystallization experiments at 800 MPa and ƒO2 = QFM+1.6 ± 0.4 (1$\sigma$) (where QFM refers to the quartz-fayalite-magnetite buffer) on a high-Al, basaltic starting material modeled after a Buldir lava. Experimental conditions were informed by olivine-hosted melt inclusions that record minimum entrapment pressures as high as 570 MPa, >6 wt.% H2O, and ƒO2 of QFM+1.4 (±0.2), making Buldir one of the most oxidized and wettest arc volcanoes documented globally. The experiments produce melts with Si-enrichment and Fe-depletion signatures characteristic of evolved, calc-alkaline magmas at the lowest MgO, although FeO* remains roughly constant over most of the experimental temperature range. Experiments saturate CrAl-spinel and olivine at 1160oC, followed by clinopyroxene and Al-spinel at 1085oC, hornblende at 1060oC, and, finally, plagioclase and magnetite between 1040oC and 960oC. Hornblende crystallization, not magnetite, generates the largest increase in SiO2 and largest decrease in FeO* in coexisting melts. Compositions of melt inclusions are consistent with experimental melts and reflect crystallization of a basaltic parent magma at high PH2O. In contrast, the whole rock compositional trends are influenced by magma mixing and phenocryst redistribution and accumulation. The crystallization experiments and natural liquids (melt inclusions and groundmass glass) from Buldir suggest that for an oxidized, hydrous primary basalt starting composition, significant Fe-depletion from the melt will not occur until intermediate to late stages of magma crystallization (< ~4.5 wt.% MgO). We conclude that the Buldir whole rock trend cannot be reproduced by crystallization at arc-relevant oxygen fugacities and is not a true liquid line of descent, warranting caution when interpreting volcanic trends globally.

Long-term patterns of post-fire harvest diverge among ownerships in the Pacific West, U.S.A.

Abstract Post-fire harvest (PFH) is a forest management practice designed to salvage value from burned timber, mitigate safety hazards from dead trees, reduce long-term fuels, and prepare sites for replanting. Despite public controversy and extensive ecological research, little is known about how much PFH occurs on private and public lands in the U.S. Pacific West, or how practices changed with shifting forest policy and increasing area burned over the last three decades. We mapped PFH across 2.2M burned hectares in California, Oregon, and Washington between 1986-2017 and used time series intervention analysis to compare trends in area, rate (% of burned area harvested), and mean patch size between private (0.5M ha) and federal (1.6M ha) forest land and across a gradient of burn severity. Harvest rates varied by ownership (4.9% federal, 18.6% private, 8.0% overall), and practices evolved and diverged over the study period. PFH area and rate declined across all ownerships in the mid-1990s during a period of reduced fire activity. As area burned increased between the early 2000s and late 2010s, PFH area rebounded and surpassed late-1980s levels, while rates remained relatively low. On federal lands, PFH practices shifted in the early-to-mid 1990s towards lower rates (10.3% to 3.8%) and smaller patches (6.0 to 3.3 ha), following policy changes and increased litigation. PFH rates on federal lands decreased at all levels of burn severity, with the largest decreases (6.2% to 1.2%) in forests with low tree mortality (i.e. fire refugia). Conversely, private PFH rates and mean patch sizes more than doubled in forests burned at very low-to-moderate severity. Our results highlight how PFH practices have shifted with policy, socio-economic pressure, and increasing area burned over 31 years in the Pacific West. A similar area of post-fire harvest is now dispersed over larger fires, with practices diverging substantially between ownerships.

The effect of trauma-focused therapy on voice-hearing: An experience sampling study.

We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD. This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group. Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD. The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = -0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001). Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices.

The effect on habitual dietary vitamin D intake of changing to a plant-based diet

The number of people following a plant-based (PB) diet has increased in recent years. This has led to concerns regarding vitamin D intake, as natural dietary sources of vitamin D are primarily animal based(1) and cross-sectional studies have reported lower intakes amongst vegetarians and vegans(2). Some PB foods, primarily dairy alternatives, are now fortified with vitamin D. Whilst vitamin D is synthesised in the skin following exposure to UV light, this does not happen in the autumn and winter months in areas of northern latitude (such as the UK). Hence, dietary supply of vitamin D becomes particularly important. This study aimed to investigate whether it is possible to maintain dietary vitamin D intake when transitioning to a PB diet, through careful choice of PB alternatives.A subset of 4-day diet diaries, from 81 women (72 Caucasian and 9 South Asian, mean age 52 ± 12y) living in South East England, was randomly selected from those collected for the D-FINES study (Vitamin D, Food Intake, Nutrition and Exposure to Sunlight in Southern England, 2006–2007; FSA funded Project N05064, NHS REC 06/Q1909/1)(3)and analysed for vitamin D intake. No subjects followed an entirely PB diet at baseline. Data modelling was carried out to substitute animal-based foods with equivalent amounts of PB alternatives. For dairy products, the equivalent fortified PB alternatives were chosen. Meat, fish and eggs were replaced with equivalent amounts of protein from PB sources, such as lentils and tofu, as no fortified direct alternatives were found. The diaries were then re-analysed. Pre- and post-substitution intakes were compared by paired t test, and ethnic groups by independent t test.There were no differences in Vitamin D intake between ethnicities either at baseline (p = 0.087) or post-substitution (p = 0.361). Vitamin D intake increased in the South Asian group post-substitution (from 2.4 ± 1.3 to 4.3 ± 1.8 µg/day, p = 0.002), with no change observed in the Caucasian group (3.6 ± 2.0 to 3.7 ± 1.8 µg/day, p = 0.660). There was no difference between vitamin D intake pre- and post-substitution overall (3.5 ± 2.0 and 3.8 ± 1.8 µg/day respectively, p = 0.222). Twenty cases decreased by ≥1 µg/day, all in the Caucasian group, with the largest decrease being from 9.6 to 2.2 µg/day.This study demonstrates that it is possible to move to a PB diet, whilst maintaining existing dietary patterns, without a reduction in vitamin D intake, but it is largely dependent on dairy intake in the original diet, as no meat/fish substitutes in the UK are currently fortified. It also requires care when choosing PB dairy substitutions as many, including organic options, are not fortified. Mean daily intakes, both pre- and post-substitution, were substantially below the recommended intake of 10 µg/day(4), suggesting that supplementation may be necessary, particularly during winter months.

Geospatial Hot Spots and Cold Spots in US Cancer Disparities and Associated Risk Factors, 2004-2008 to 2014-2018.

Despite declining cancer death rates in the US, cancer remains the second deadliest disease and disparities persist. Although research has focused on identifying risk factors for cancer deaths and associated disparities, few studies have examined how these relationships vary over time and space. The primary objective of this study was to identify cancer mortality hot spots and cold spots - areas where cancer death rates decreased less than or more than neighboring areas over time. A secondary objective was to identify risk factors of cancer mortality hot spots and cold spots. We analyzed county-level cancer death rates from 2004 through 2008 and 2014 through 2018, exploring disparities in changes over time for socioeconomic and demographic variables. We used hot spot analysis to identify areas with larger decreases (cold spots) and smaller decreases (hot spots) in cancer death rates and random forest machine learning analysis to assess the relative importance of risk factors associated with hot spots and cold spots. We mapped spatial clustering areas. Geospatial analysis showed hot spots predominantly in the Plains states and Midwest and cold spots in the Southeast, Northeast, 2 Mountain West states (Utah and Idaho), and a portion of Texas. Factors with the strongest influence on hot spots and cold spots were unemployment, preventable hospital stays, mammography screening, and high school education. Geospatial disparities in changes in cancer death rates point out the critical role of access to care, socioeconomic position, and health behaviors in persistent cancer mortality disparities. Study results provide insights for interventions and policies that focus on addressing health care access and social determinants of health.

Potensi Batang Pisang sebagai Media Filter pada Pengolahan Air Limbah Laundry

Banana stems have the potential to be used as filter media in the laundry wastewater treatment process. Laundry wastewater will contain hazardous substances that have the potential to pollute the environment if it is not treated adequately before disposal. Considering the fact that banana stems have a high hygroscopic capacity and cellulose content which is capable of absorbing inorganic chemicals, the use of banana stems as a filter media is considered a realistic option. The research method used is the filtration reactor method, and there are differences in the amount of time invested and the thickness of the banana stem, which can range from 20 to 40 centimeters. There were differences in the decrease in the parameter values of pH, COD, TSS, phosphate, and MBAS with variations in the thickness of the banana stem media. The largest decrease in pH observed occurred at a media thickness of 40 centimeters. Based on the research results, it was found that there was variation in the extent to which parameters were reduced overall. A one-day soak is the most effective way to reduce the severity of these properties. In addition, research findings show that banana stems are not effective enough in processing laundry wastewater.

Mindfulness Exercises Reduce Acute Physiologic Stress Among Female Clinicians.

Approximately 50% of clinicians experience excessive emotional, physical, and mental stress, with repercussions across the entire medical system. Mindfulness exercises may mitigate this excessive stress. Heart rate variability (HRV) is an objective stress measure that can quantify which mindfulness exercises provide the greatest stress reduction. To define the impact of specific mindfulness exercises on HRV, a surrogate for physiologic stress, and the relationship between physiologic (HRV) and subjective stress measured by the State-Trait Anxiety Inventory during a one-day mindfulness workshop. This was a prospective observational pilot study performed at a quaternary children's hospital with diverse subspecialists of pediatric nurses, nurse practitioners, and physicians. Our primary outcome measure was change in HRV from baseline during three mindfulness exercises. The grounding, deep breathing, and body scan exercises all produced statistically significant changes in HRV among our 13 female participants. The body scan exercise produced statistically significant changes in all studied HRV parameters compared with baseline. We observed significant increases in Root Mean Square of Successive Differences between normal heartbeats (p = 0.026), high frequency (p ≤ 0.001), and the parasympathetic nervous system index (p ≤ 0.001) reflecting increased parasympathetic tone (e.g., relaxation), whereas sd 2/sd 1 ratio (p ≤ 0.001) and the stress index (p = 0.004) were decreased reflecting sympathetic withdrawal (e.g., decreased stress). Subjective stress decreased after 1-day mindfulness training (44.6 to 27.2) (p < 0.001). Individuals with the largest decrease in subjective stress also had the most improvement in HRV during the body scan exercise. Clinician stress levels (HRV) improved after participating in grounding, deep breathing, and body scan meditations, which may highlight their importance as stress reduction tools for clinicians. Monitoring of HRV during mindfulness exercises may provide deeper understanding of which specific exercises produce the greatest physiologic stress reduction for individual participants and the trend of these changes over time.

Bayesian network model of ethno-racial disparities in cardiometabolic-based chronic disease using NHANES 1999-2018.

Ethno-racial disparities in cardiometabolic diseases are driven by socioeconomic, behavioral, and environmental factors. Bayesian networks offer an approach to analyze the complex interaction of the multi-tiered modifiable factors and non-modifiable demographics that influence the incidence and progression of cardiometabolic disease. In this study, we learn the structure and parameters of a Bayesian network based on 20 years of data from the US National Health and Nutrition Examination Survey to explore the pathways mediating associations between ethno-racial group and cardiometabolic outcomes. The impact of different factors on cardiometabolic outcomes by ethno-racial group is analyzed using conditional probability queries. Multiple pathways mediate the indirect association from ethno-racial group to cardiometabolic outcomes: (1) ethno-racial group to education and to behavioral factors (diet); (2) education to behavioral factors (smoking, physical activity, and-via income-to alcohol); (3) and behavioral factors to adiposity-based chronic disease (ABCD) and then other cardiometabolic drivers. Improved diet and physical activity are associated with a larger decrease in probability of ABCD stage 4 among non-Hispanic White (NHW) individuals compared to non-Hispanic Black (NHB) and Hispanic (HI) individuals. Education, income, and behavioral factors mediate ethno-racial disparities in cardiometabolic outcomes, but traditional behavioral factors (diet and physical activity) are less influential among NHB or HI individuals compared to NHW individuals. This suggests the greater contribution of unmeasured individual- and/or neighborhood-level structural determinants of health that impact cardiometabolic drivers among NHB and HI individuals. Further study is needed to discover the nature of these unmeasured determinants to guide cardiometabolic care in diverse populations.

From Early Behavioral Intervention to School: A Systematic Evaluation of Parents' Perspectives on the Quality of the Autism Services During the Transition to Kindergarten.

Research emphasizes the importance of seamless transitions from Early Behavioral Intervention (EBI) to school-based services, but formal support during this critical period remains limited, leading to decreased parental satisfaction with autism services. This study aimed to systematically document parents' perception of the quality of services received during the transition from EBI to kindergarten, along with the predictors of this perception. The study adopted a prospective longitudinal design and relied on a validated evaluation framework, the Evaluation of the Trajectory in Autism for Parents (ETAP). ETAP allows to investigate five critical determinants (accessibility, continuity, validity, flexibility, empathy) of service quality, as rated by parents (N = 138 families), which were evaluated at three critical periods of the transition: end of EBI, beginning and end of first year of school. Quality ratings indicated generally positive perceptions but showed small to medium effect size decreases over time; validity had the largest decrease. Predictors of quality ratings and changes in ratings differed by phase of the transition and included child characteristics (gender, age, disabilities, challenging behavior), parent characteristics (maternal origin, fluency in the official language of the province, education level), and family characteristics (number of children). This study's comprehensive analysis of service quality determinants and possible risk and protective factors provides insights into improving support for families navigating the transition to school.Keywords: Autism, Early behavioral intervention, School transition, Parental perception, Service quality, Evaluation framework.

Trends in Special Education Identification During the COVID-19 Pandemic: Evidence From Michigan

We use data from Michigan and an interrupted time series strategy to show how the COVID-19 pandemic impacted special education identifications and discontinuations. We find a substantial decrease in K–5 identifications and discontinuations during the 2019 to 2020 and 2020 to 2021 school years. Identifications fell by 19% and 12% in the first two pandemic years, with smaller but still significant reductions in discontinuations. Districts with remote schooling and Black, Asian, and economically disadvantaged students saw larger decreases in identifications. By 2021 to 2022 rates returned to trend and continued to grow in 2022 to 2023, albeit at a similar rate to pre-pandemic. This suggests some “catch-up” accounting for delayed or missed identifications but likely not enough at this point to overcome the pandemic induced deficit.

Road casualties analysis

This article examines the circumstances of road casualties over the period 2012–2021 in Greater Manchester in North West England. In particular, the demographics of road casualties, the nature of the road activity involved, and the nature of the roads where the casualties occurred are examined. Over the period studied there was an overall decrease in road casualties, similar to that of Great Britain overall, and there were 1.55 times as many male as female road casualties. The largest decrease in road casualties by age group was amongst those aged less than 18. The majority of road casualties occurred on urban roads with a speed limit of 21–30 mph. There was a strong relationship between age group and the rate of road casualties for pedestrians, driver/riders, and passengers.

Temporal Trends in the Prevalence of Child Undernutrition in China From 2000 to 2019, With Projections of Prevalence in 2030: Cross-Sectional Analysis.

Although the problem of malnutrition among children in China has greatly improved in recent years, there is a gap compared to developed countries, and there are differences between provinces. Research on long-term comprehensive trends in child growth failure (CGF) in China is needed for further improvement. The purpose of this study was to examine trends in stunting, wasting, and underweight among children younger than 5 years in China from 2000 to 2019, and predict CGF till 2030. We conducted a cross-sectional analysis using data from the local burden of disease (LBD) database. Using Joinpoint Regression Software, we examined trends in CGF among children younger than 5 years in China from 2000 to 2019, and predicted the trends of prevalence in 2030, using the Holt-Winters model with trends but without seasonal components. The assessment was performed with Stata 17 (StataCorp). Data were analyzed from October 17, 2023, to November 22, 2023. In 2019, the prevalences of stunting, wasting, and underweight decreased to 12%, 3%, and 4%, respectively (decreases of 36.9%, 25.0%, and 42.9%, respectively, compared with the values in 2000). The prevalence of CGF decreased rapidly from 2000 to 2010, and the downward trend slowed down after 2010. Most provinces had stagnated processes of trends after 2017. The age group with the highest stunting prevalence was children aged 1 to 4 years, and the highest prevalence of wasting and underweight was noted in early neonatal infants. From 2000 to 2019, the prevalence of CGF declined in all age groups of children. The largest relative decrease in stunting and underweight was noted in children aged 1 to 4 years, and the largest decrease in wasting was noted in early neonatal infants. The prevalences of stunting, wasting, and underweight in China are estimated to decrease to 11.4%, 3.2%, and 4.1%, respectively, by 2030. China has nationally met the World Health Organization's Global Nutrition Targets for 2030 for stunting but not for wasting. This study provides data on the prevalence and trends of CGF among children younger than 5 years and reports declines in CGF. There remain areas with slow progress in China. Most units have achieved the goal for stunting prevalence but not wasting prevalence.

Transitioning from Self-Monitoring of Blood Glucose to Continuous Glucose Monitoring in Combination with a mHealth App Improves Glycemic Control in People with Type 1 and Type 2 Diabetes.

Introduction: Integrating mobile health (mHealth) apps into daily diabetes management allows users to monitor and track their health data, creating a comprehensive system for managing daily diabetes activities and generating valuable real-world data. This analysis investigates the impact of transitioning from traditional self-monitoring of blood glucose (SMBG) to real-time continuous glucose monitoring (rtCGM), alongside the use of a mHealth app, on users' glycemic control. Methods: Data were collected from 1271 diabetes type 1 and type 2 users of the mySugr® app who made a minimum of 50 SMBG logs 1 month before transitioning to rtCGM and then used rtCGM for at least 6 months. The mean and coefficient of variation of glucose, along with the proportions of glycemic measurements in and out of range, were compared between baseline and 1, 2, 3, and 6 months of rtCGM use. A mixed-effects linear regression model was built to quantify the specific effects of transitioning to a rtCGM sensor in different subsamples. A novel validation analysis ensured that the aggregated metrics from SMBG and rtCGM were comparable. Results: Transitioning to a rtCGM sensor significantly improved glycemic control in the entire cohort, particularly among new users of the mySugr app. Additionally, the sustainability of the change in glucose in the entire cohort was confirmed throughout the observation period. People with type 1 and type 2 diabetes exhibited distinct variations, with type 1 experiencing a greater reduction in glycemic variance, while type 2 displayed a relatively larger decrease in monthly averages.

Over a Shadowed Threshold: Supreme Court of British Columbia Litigation Activity 1992-2022

The Supreme Court of British Columbia between 2002 to 2022 published “Annual Reports” that include information and statistics from 1992 to 2022 concerning Court litigation and activities. Compiled Annual Report data and calculations permit the first long-duration survey of different litigation type volumes, specific process activities, and the frequency at which court and judicial resources could not support scheduled proceedings in a provincial superior court of inherent jurisdiction. The resulting observations in this article are strong support for further and expanded quantitative investigation and evaluation of Canadian courts and their operation. While the overall volume of new Supreme Court of British Columbia activity is generally stable, extended timeline data reveals long-duration shifts in the frequency of certain litigation types, and a general decrease in trial volume, with the largest decreases being in criminal subject litigation. However, the volume of “long chambers” interlocutory processes has remained stable.

A comparison of the renal function biomarkers serum creatinine, pro-enkephalin and cystatin C to predict clearance of pemetrexed

IntroductionFor drugs with a narrow therapeutic window, there is a delicate balance between efficacy and toxicity, thus it is pivotal to administer the right dose from the first administration onwards. Exposure of pemetrexed, a cytotoxic drug used in lung cancer treatment, is dictated by kidney function. To facilitate optimized dosing of pemetrexed, accurate prediction of drug clearance is pivotal. Therefore, the aim of this study was to investigate the performance of the kidney function biomarkers serum creatinine, cystatin C and pro-enkephalin in terms of predicting the elimination of pemetrexed.MethodsWe performed a population pharmacokinetic analysis using a dataset from two clinical trials containing pharmacokinetic data of pemetrexed and measurements of all three biomarkers. A three-compartment model without covariates was fitted to the data and the obtained individual empirical Bayes estimates for pemetrexed clearance were considered the “true” values (Cltrue). Subsequently, the following algorithms were tested as covariates for pemetrexed clearance: the Chronic Kidney Disease Epidemiology Collaboration equation using creatinine (CKD-EPICR), cystatin C (CKD-EPICYS), a combination of both (CKD-EPICR-CYS), pro-enkephalin as an absolute value or in a combined algorithm with age and serum creatinine, and lastly, a combination of pro-enkephalin with cystatin C.ResultsThe dataset consisted of 66 subjects with paired observations for all three kidney function biomarkers. Inclusion of CKD-EPICR-CYS as a covariate on pemetrexed clearance resulted in the best model fit, with the largest decrease in objective function (p < 0.00001) and explaining 35% of the total inter-individual variability in clearance. The predictive performance of the model to containing CKD-EPICR-CYS to predict pemetrexed clearance was good with a normalized root mean squared error and mean prediction error of 19.9% and 1.2%, respectively.ConclusionsIn conclusion, this study showed that the combined CKD-EPICR-CYS performs best in terms predicting pharmacokinetics of pemetrexed. Despite the hypothesized disadvantages, creatinine remains to be a suitable and readily available marker to predict pemetrexed clearance in clinical practice.

Implications of the initial braidwood v. Becerra ruling for colorectal cancer outcomes: a modeling study.

The Affordable Care Act (ACA) eliminated patient cost-sharing for USPSTF recommended services. However, if the US Court of Appeals for the Fifth Circuit fully upheld a US District Court ruling in Braidwood Management v. Becerra, 666 F. Supp. 3d 613 (N.D. Tex 2023), cost-sharing for USPSTF recommendations made after ACA passage would have been reinstated for over 150 million people. The case could still reinstate cost-sharing for colorectal cancer (CRC) screening for ages 45-49 years and for polyp removal during (diagnostic) colonoscopy across all ages. Using the MISCAN-Colon model, we simulated the potential impact on CRC outcomes, assuming early-onset CRC trends, and lower screening participation. An 8-percentage-points decline in screening participation could increase CRC incidence by 5.1%, and CRC mortality by 9.1%, with slightly lower costs due to increased cost-sharing. Larger decreases in screening participation can result in higher costs from increased incidence and delayed diagnoses.