Median Percentile Research Articles

The minimal clinically important difference of the Participation Measurement Scale in chronic stroke

Background: The Participation Measurement Scale (PM-Scale) is an International Classification of Functioning, Disability and Health-based and Rasch-built scale developed specifically to assess participation in people with stroke.Objectives: Our study aimed to estimate the minimal clinically important difference (MCID) for the PM-Scale.Method: We performed a secondary analysis of data from the ‘Circuit walking, balance, cycling and strength training’ trial. Participants underwent mixed and collective physical activities or sociocultural activities for 12 weeks, and participation data were collected before and after the interventions. The activity limitations (ACTIVLIM)-Stroke scale was used as the anchor of importance. The MCID for the PM-Scale was estimated using receiver operating characteristic (ROC) curves and the Youden index.Results: Data were collected from 46 people with chronic stroke, of which 22% were female, with median (Percentile 25, Percentile 75) age of 54 (44; 60) years, and time since stroke is 24 (11; 37) months. For all participants, the PM-Scale measures range from –2.98 logits to 5.02 logits. The area under the curve (AUC) for the receiver operating characteristic (ROC)-analysis was 0.74 yielding an estimated MCID of 1.98 logit for the PM-Scale.Conclusion: Our study estimated the MCID of the PM-Scale at 1.98 logit, enabling a more precise interpretation of the outcome in the clinical and research settings.Clinical implications: An improvement of at least 1.98 logit on the PM-Scale is required to induce a clinical change in the independence in activities of daily living in people with chronic stroke.

Multivariate generalized variance control chart under sensitizing rules with an application in petroleum process

. In this study, a multivariate generalized variance (MGV) control chart with sensitizing rules is introduced for efficiently monitoring of small-to-moderate variations in the variance-covariance matrix. On this subject, control limit is constructed which depends on the probability of single point (PSP) and prefixed in-control average run length (ARL). To find the PSP such that in-control ARL remains almost equal to prefixed level, a single polynomial equation (SPE) is considered. Moreover, performance of the proposed MGV control chart is evaluated using individual and overall performance measures. Results reveal that behavior of the proposed multivariate generalized variance (MGV) control chart is remained consistent for all choices of sensitizing rules when process is in-control. The in-control ARL is resulted equal to the prefixed in-control ARL. Also, behavior of in-control median run length (MRL) and percentile run length (PRL) is observed similar for all choices of sensitizing rules. A comparative analysis revealed that proposed MGV control chart with an additional sensitizing rules outperformed for detection of small-to-moderate variations relative to the existing control charts with classical rule. Besides, the proposed MGV control chart is applied to petrolatum process as an application for monitoring the three physical diesel characteristics simultaneously.

Dietary inflammation and childhood adiposity: Analysis of individual participant data from six birth cohorts.

Childhood adiposity and inflammation impact long-term health. However, associations between dietary inflammation and childhood adiposity are unclear. We investigated if more pro-inflammatory diets are associated with greater adiposity in early-, mid-, and late-childhood. We pooled individual participant data (IPD) from 13,978 children in six European birth cohorts in the ALPHABET consortium: Lifeways Cross-Generation Cohort Study (Lifeways), the Randomised cOntrol trial of LOw glycaemic index diet during pregnancy study (ROLO), the Avon Longitudinal Study of Parents and Children (ALSPAC), the Southampton Women's Survey (SWS), the Polish Mother and Child Cohort (REPRO_PL), and The Generation R Study (Generation R). Dietary inflammation was determined using the Children's Dietary Inflammatory Index (C-DII™). Adiposity-related outcomes included BMI z-score (primary outcome), abdominal circumference, skinfolds, fat-mass- and fat-free-mass-indices (secondary outcomes). Two-stage random effects IPD meta-analysis (IPD-MA), with adjusted linear and logistic regression models, was conducted. Quantile regression (QR) examined C-DII associations with BMI z-score percentiles. Median, 25th and 75th percentile C-DII scores trended upwards from early 0.18 (-0.65, 1.03) to late-childhood 0.51 (-0.40, 1.49). Pooled QR revealed positive C-DII associations across BMI z-score percentiles, particularly in late-childhood unadjusted β (95% CI) 75th (0.075 (0.046, 0.105), p<0.001); 85th (0.077 (0.045, 0.108), p<0.001); and 95th (0.051 (0.011, 0.091), p=0.01). Adjusted cohort-specific QR identified contrasting associations at early-childhood (ALSPAC and SWS) and late-childhood (Generation R). Pooled adjusted IPD-MA showed C-DII associations with late-childhood obesity [OR (95% CI) 0.89 (0.81, 0.97), p=0.01]. C-DII associations across BMI z-score distribution varied by cohort, quantile, and time-point, with some potentially explained by adiposity rebound, reverse causation and questionnaire response biases, highlighting insights not evident with linear regression.

Effect of Risk-Taking Propensity on Entrepreneurial Intentions among Students Undertaking Entrepreneurial Course in Universities in Meru and Tharaka Nithi Counties

The concept of entrepreneurship has received increasing attention in various countries globally, especially in developing countries which suffer from several problems that hinder economic growth. Entrepreneurship is essential in addressing economic problems, such as unemployment, new wealth creation, stabilizing society, increasing industrial competition and economic development. The main objective of this study was to determine the effect of risk taking propensity on entrepreneurial intentions among students in universities in Meru and Tharaka Nithi counties. This study was conducted among university students since the students had undertaken entrepreneurial training to become future entrepreneurs. Descriptive research was adopted. The target population of this study was 800 students and a sample size of 267 respondents who were in third and fourth years and had undertaken entrepreneurial studies as a unit or major course at the universities. This study was anchored on theory of planned behavior and entrepreneurship event model of entrepreneurship. A questionnaire was used to guide in collecting primary data. Data obtained from this study was interpreted using descriptive statistical methods including tables, mean, median, mode and simple percentiles. Data was analyzed using inferential statistics with help of SPSS. Multiple regression analysis was used to analyze the relationship between variables using confidence level of 95%. The study found a regression coefficient of risk taking propensity was 0.187 and a p-value of 0.000&lt;0.05 hence risk taking propensity had a positive and statistically significant effect on entrepreneurial intentions. It is recommended that Universities should encourage and create an environment that fosters calculated risk taking and confidence among the students to believe in their abilities, identify and take up opportunities available

Classification of childhood obesity using longitudinal clinical body mass index and its validation.

Persistence of childhood adiposity is known to be associated with long-term adverse cardiometabolic risks. Yet, cross-sectional body mass index (BMI) is often used to classify obesity in clinical care and research. This study aimed to develop and validate a childhood obesity classification system using longitudinal clinical data. This observational study used electronic health record data from a tertiary care hospital, with replication in an independent cohort. For individuals with ≥ 3 BMI measurements, the median BMI percentile and persistence in the obesity class were used for longitudinal classification. The association between longitudinal BMI class and early onset obesity, socioeconomic status (SES), and adverse cardiometabolic risk was analyzed. Height, weight, and cardiometabolic risk measures were obtained for 22 352 children from 2014-18 in the primary cohort and 24 444 children in the replication cohort. Obesity (BMI ≥ 95th percentile [BMIpct95]) was observed in 24.1% and severe obesity (BMI ≥ 120% of BMIpct95) in 10.6%. Individuals with early onset obesity (age ≤ 6 years) remained in the same or higher obesity class; those in the high-SES group had lower odds of obesity. The proportion of individuals with cardiometabolic risk increased with increasing obesity severity (p-value 0.01 - < 0.001). The AUC for cardiometabolic risk by longitudinal BMI class was higher compared to that for cross-sectional BMI (80.0% vs. 75.8%, p < 0.001). The Longitudinal BMI classification may better reflect long-term cardiometabolic risk in children. This classification can be useful for focused intervention strategies and for profiling of individuals for genetic testing.

Retrospective evaluation of the efficacy of ultrasound-guided intra-articular hyaluronic-acid- based injections (Hyalubrix®) in patients with glenohumeral osteoarthritis.

Intra-articular injections of hyaluronic acid (HA) have been reported to alleviate pain, reduce disability, and improve joint function in glenohumeral osteoarthritis (GH-OA). This retrospective study aimed to evaluate the effectiveness of a HA-based formulation (Hyalubrix®) in reducing the pain of patients with GH-OA and improving both patient's shoulder functions and quality of life (QoL). Data collected during the standard clinical practice of the center was retrospectively analyzed. The Simple Shoulder Test (SST) questionnaire reported data on the patient's ability to perform daily activities; the Euro-Quality of Life Health Assessment (EQ-5D) collected evidence on QoL; and changes in pain were evaluated through the Visual Analog Scale (VAS). SST and EQ-5D scores were analyzed comparing baseline values with those at the last follow-up, while VAS was investigated for all the available visits. Continuous values were summarized as mean ± standard deviation, median, and 25-75th percentiles. Shapiro-Wilk test assessed normality, with significance set at p<0.05, and no adjustments for multiple comparisons were made. All scores showed a significant improvement: VAS decreased from 55.4±13.8 to 16.2±16.3 (p<0.001), the SST increased from 38.0 to 65.5 (p<0.001), as well as the EQ-5D (from 41.7 to 76.7; p<0.001). GH-OA treatment with Hyalubrix® proved to be highly beneficial, leading to complete pain reduction in more than 50% of patients and a significant reduction in 27.5% of cases. This resulted in improved joint function and QoL.

Assessment of the risks of impacts of heavy metals and arsenic entering the human body with herbal medicines

Introduction. Liquid dosage forms based on medicinal plant raw materials are very convenient to use and must meet safety requirements. In the context of harmonization of pharmacopoeial requirements, determining the total content of heavy metals in tinctures is not enough. Risk assessment is necessary to calculate the permissible concentrations of heavy metals in tinctures.Aim. To assess the safety of using tinctures in terms of the content of heavy metals and arsenic within the framework of a risk-oriented strategy.Materials and methods. The objects of the study were 20 samples of valerian and motherwort tinctures manufactured by various enterprises. The quantitative content of 15 elements (As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Mo, Ni, Pb, Sr, Tl, V, Zn) was determined by inductively coupled plasma mass spectrometry.Results and discussion. The concentrations of elements in tinctures varied in the range of 0–1.84 μg/g. Manganese and zinc were found in maximum quantities, while cadmium, molybdenum and vanadium were found in minimum quantities. Mercury was not detected in any of the samples. The content of toxic elements in the tinctures did not exceed the levels of permissible concentrations regulated by the normative documentation of the Russian Federation. Total hazard indices (HI) were calculated at the levels of the median and 90th percentile of the content of elemental toxicants. In the tinctures, they were, respectively: valerian – 0.016 · 10–5 and 0.027 · 10–5, motherwort – 0.022 · 10–5 and 0.028 · 10–5. The obtained values were significantly lower than 1.0. Calculation of individual carcinogenic risk (CR) of elemental carcinogens (Cd, As, Cr, Pb) entering the body with tinctures of valerian and motherwort showed that the CR values were in the range of 4.9 · 10–9–6.84 · 10–7, which did not exceed the permissible threshold value (1 · 10–6).Conclusions. The actual content of toxic elements (Pb, Cd, As, Hg) in tinctures of valerian and motherwort was 0–0.006 μg/g, which did not exceed the levels of permissible concentrations. Calculations of non-carcinogenic risks when using tinctures of valerian and motherwort showed that the total impact of 15 studied elements on human health when consuming a daily dose of tinctures is characterized as permissible, periodic monitoring of the content of non-standardized elements in samples of herbal medicines is not required. It was established that the studied tinctures of valerian and motherwort are not oncogenic factors and do not require risk reduction measures.

Recent Trends in Academic Vs Non-academic Radiologist Compensation and Clinical Productivity.

Recent radiologist compensation and clinical productivity trends have not been well characterized, especially across academic vs. non-academic practice settings. To assess recent trends in in financial compensation and clinical productivity between academic and non-academic settings in diagnostic (DR) and interventional radiology (IR). We studied deidentified data from the Medical Group Management Association (MGMA) for both DR and IR radiologists in academic and non-academic practices from 2014 to 2023. Median, 25th and 75th percentile, and mean values were analyzed for compensation, collections and work relative-value-units (wRVUs). Compensation and productivity data were compared by radiology subspecialty (DR vs IR), practice type (academic vs non-academic provider), geographical region of the US, and practice size. Trends in absolute changes were analyzed with linear regression. The MGMA Survey data for 2023 included responses for 3769 radiologists (2883 in DR and 886 in IR). In 2023, non-academic radiologists had greater total median compensation than academic faculty in both DR (by 27%) and IR (by 32%). From 2014 to 2023, median compensation increased faster for academic DRs (3.2% annually) than for non-academic DRs (1.9% annually). In 2023, DRs produced greater median wRVUs than IRs (by 53 % for non-academic and 46 % for academic radiologists) with higher collections, but IRs had higher compensation (by 16% in non-academic and 10% in academic settings). Over the last decade, IR physician compensation increased by 3.9% and 3.4% annually for non-academic and academic IR physicians respectively while median work RVUs trended downward (by -1.5 % for non-academic and -2.4 % for academic physicians) with declining collections (by -4.4 % annually for non-academic and -2.1 % for academic physicians). Over the last decade, the salary gap between academic and non-academic radiologists has narrowed. Physician compensation has increased at a faster pace in IR, despite relatively lower clinical productivity and declining collections.

Quantifying Streambed Grain Size, Uncertainty, and Hydrobiogeochemical Parameters Using Machine Learning Model YOLO

AbstractStreambed grain sizes control river hydro‐biogeochemical (HBGC) processes and functions. However, measuring their quantities, distributions, and uncertainties is challenging due to the diversity and heterogeneity of natural streams. This work presents a photo‐driven, artificial intelligence (AI)‐enabled, and theory‐based workflow for extracting the quantities, distributions, and uncertainties of streambed grain sizes from photos. Specifically, we first trained You Only Look Once, an object detection AI, using 11,977 grain labels from 36 photos collected from nine different stream environments. We demonstrated its accuracy with a coefficient of determination of 0.98, a Nash–Sutcliffe efficiency of 0.98, and a mean absolute relative error of 6.65% in predicting the median grain size of 20 ground‐truth photos representing nine typical stream environments. The AI is then used to extract the grain size distributions and determine their characteristic grain sizes, including the 10th, 50th, 60th, and 84th percentiles, for 1,999 photos taken at 66 sites within a watershed in the Northwest US. The results indicate that the 10th, median, 60th, and 84th percentiles of the grain sizes follow log‐normal distributions, with most likely values of 2.49, 6.62, 7.68, and 10.78 cm, respectively. The average uncertainties associated with these values are 9.70%, 7.33%, 9.27%, and 11.11%, respectively. These data allow for the computation of the quantities, distributions, and uncertainties of streambed HBGC parameters, including Manning's coefficient, Darcy‐Weisbach friction factor, top layer interstitial velocity magnitude, and nitrate uptake velocity. Additionally, major sources of uncertainty in grain sizes and their impact on HBGC parameters are examined.

Clinical diagnostic reference levels and image quality metrics for CT in oncology patients.

In CT, the volumetric CT dose index (CTDIvol), dose-length product (DLP) and patient's size-specific dose estimates (SSDE) are used as diagnostic reference level (DRL) metrics. To develop clinical local DRL values for CT chest-abdomen-pelvis (CAP) examinations using the CTDIvol, DLP and SSDE, and to determine the image quality achieved. In total, 201 cancer patients were included in the study. The scanning parameters, dose metrics from the CT unit and participants' body mass index (BMI) were documented. The local CT DRL values for CAP examinations were defined as the median and 75th percentiles of the dose distribution. The local DRL values given in terms of median CTDIvol ranged between 8.4 mGy and 12.7 mGy for the different types of cancers. The median DLPs ranged from 848 to 1173.4 mGy.cm for the various cancers. Generally, the radiation dose was directly proportional to the BMI and number of scan phases. Significant differences were observed between the DRLs for the various size-related parameters, number of scan phases and BMI classifications. The image quality was clinically satisfactory. No baseline data for clinical DRL values were available for this medical oncology department. The achieved DRLs were similar to published size-specific DRLs. The image quality was maintained during CT imaging. Dose optimisation and image quality assessment should be implemented to ensure optimal scanning parameters for different cancers in CT CAP examinations. The first size-specific local DRL values for CT CAP investigations carried out on oncology patients in South Africa have been established.

Large synthesis of in situ field measurements of the size distribution of mineral dust aerosols across their life cycles

Abstract. Mineral dust aerosol is important in the Earth system, and the correct representation of its size distribution is fundamental for shaping the current state and evolution of the climate. Despite many observational dust size data that are available in the literature, using this body of information to properly guide the development and validation of climate models and remote sensing retrievals remains challenging. In this study we collect, evaluate, harmonize, and synthesize 58 size distribution data from the past 50 years of in situ field observations with the aim of providing a consistent dataset to the community for use in constraining the representation of dust size across its life cycle. Four levels (LEVs) of data treatment are defined, going from original data (LEV0), data interpolated and normalized on a standardized diameter grid (LEV1), and data in which original particle diameters are converted to a common geometrical definition under both spherical (LEV2a) and aspherical (LEV2b) assumptions. Size distributions are classified as emission or source (SOURCE, &lt;1 d from emission; number of datasets in this category N=12), mid-range transport (MRT, 1–4 d of transport; N=36), and long-range transport (LRT, &gt;4 d of transport; N=10). The harmonized dataset shows consistent features suggesting the conservation of airborne particles with time and a decrease in the main coarse-mode diameter from a value on the order of 10 µm (in volume) for SOURCE dust to a value on the order of 1–2 µm for LRT conditions. An additional mode becomes evident below 0.4 µm for MRT and LRT dust. Data for the three levels (LEV1, LEV2a, and LEV2b) and the three categories (SOURCE, MRT, and LRT), together with statistical metrics (mean, median, 25th and 75th percentiles, and standard deviation), are available as follows: SOURCE (https://doi.org/10.57932/58dbe908-9394-4504-9099-74a3e77140e9, Formenti and Di Biagio, 2023a); MRT (https://doi.org/10.57932/31f2adf7-74fb-48e8-a3ef-059f663c47f1, Formenti and Di Biagio, 2023b); LRT (https://doi.org/10.57932/17dc781c-3e9d-4908-85b5-5c99e68e8f79, Formenti and Di Biagio, 2023c).

Using Joint Longitudinal and Time-to-Event Models to Improve the Parameterization of Chronic Disease Microsimulation Models: an Application to Cardiovascular Disease.

Chronic disease microsimulation models often simulate disease incidence as a function of risk factors that evolve over time (e.g., blood pressure increasing with age) in order to facilitate decision analyses of different disease screening and prevention strategies. Existing models typically rely on incidence rates estimated with standard survival analysis techniques (e.g., proportional hazards from baseline data) that are not designed to be continually updated each model cycle. We introduce the use of joint longitudinal and time-to-event to parameterize microsimulations to avoid potential issues from using these existing methods. These joint models include random effects regressions to estimate the risk factor trajectories and a survival model to predict disease risk based on those estimated trajectories. In a case study on cardiovascular disease (CVD), we compare the validity of microsimulation models parameterized with this joint model approach to those parameterized with the standard approaches. A CVD microsimulation model was constructed that modeled the trajectory of seven CVD risk factors/predictors as a function of age (smoking, diabetes, systolic blood pressure, antihypertensive medication use, total cholesterol, HDL, and statin use) and predicted yearly CVD incidence as a function of these predictors, plus age, sex, and race. We parameterized the model using data from the Atherosclerosis Risk in Communities study (ARIC). The risk of CVD in the microsimulation was parameterized with three approaches: (1) joint longitudinal and time-to-event model, (2) proportional hazards model estimated using baseline data, and (3) proportional hazards model estimated using time-varying data. We accounted for non-CVD mortality across all the parameterization approaches. We simulated risk factor trajectories and CVD incidence from age 70y to 85y for an external test set comprised of individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). We compared the simulated to observed incidence using both average survival curves and the E50 and E90 calibration metrics (the median and 90th percentile absolute difference between observed and predicted incidence) to measure the validity of each parameterization approach. The average CVD survival curve estimated by the microsimulation model parameterized with the joint model approach matched the observed curve from the test set relatively closely. The other parameterization methods generally performed worse, especially the proportional hazards model estimated using baseline data. Similar results were observed for the calibration metrics, with the joint model performing particularly well on the E90 metric compared to the other models. Using a joint longitudinal and time-to-event model to parameterize a CVD simulation model produced incidence predictions that more accurately reflected observed data than a model parameterized with standard approaches. This parameterization approach could lead to more reliable microsimulation models, especially for models that evaluate policies which depend on tracking dynamic risk factors over time. Beyond this single case study, more work is needed to identify the specific circumstances where the joint model approach will outperform existing methods.

China's GDP at risk: The role of housing prices

This paper studies the impact of house prices on the distribution of GDP growth in China (the 5th, median, and 95th percentiles). We show that house price appre-ciation positively affects future GDP growth, with a more significant impact on the tail outcomes - GDP at risk. Moreover, we find that housing bust is associated with GDP growth vulnerability; a sharp decline in house prices generates severe economic downturns. Our finding is supported by the investment channel, a housing boom stim-ulates investment, which boosts GDP growth. However, the subsequent housing bust suppresses investment, leading to increased downside risks to GDP growth.

A-211 Lipids in the Afternoon: Effect on LDL-C, Triglycerides, and Collection Time When Removing Fasting Requirements for Lipid Panels

Abstract Background Calculated LDL cholesterol (LDL-C) is a standard component of the lipid panel and an important risk factor in managing atherosclerotic cardiovascular disease (ASCVD). Due to the assumptions in the derivation of the Friedwald formula, fasting (≥8 hours) and triglyceride levels ≤400mg/dL have long been recommended. More recent data have shown that in most cases fasting has minimal effect on results, leading to the endorsement of non-fasting lipid panels for routine evaluation of ASCVD risk in clinical practice guidelines. Furthermore, newer equations (e.g. Sampson-NIH) allow for more accurate estimation of LDL-C even in the presence of hypertriglyceridemia. Mayo Clinic has implemented the Sampson-NIH LDL-C calculation and removed fasting/non-fasting designation from lipid panel orders. We hypothesized that the change to fasting designation would allow more afternoon draws for routine lipid panels and that increased non-fasting collections may increase triglyceride levels, but that the Sampson-NIH equation would prevent bias in LDL-C estimation. In order to test these hypotheses, we analyzed patient data from 1 year prior and 1 year post-implementation. Methods Results of lipid panels performed for one year preceding (n=334,719) and one year after (n=381,804) removal of the fasting/non-fasting designation and implementation of Sampson-NIH equation were collected. Median, 10th, and 90th percentile of draw time, triglyceride, and LDL-C calculated by either Sampson-NIH or Friedwald formulas were compared by quantile regression. Results Draw times shifted post-implementation at the 10th percentile (7:06 vs. 7:10, p&amp;lt;0.0001), median (8:49 vs. 9:08, p&amp;lt;0.0001) and 90th (12:02 vs. 13:46, p&amp;lt;0.0001). No difference in median triglyceride measurement was observed between pre-and post-implementation (110mg/dL), but slight differences were observed in the 10th and 90th percentile values (60 vs 59mg/dL and 224 vs 229mg/dL, p&amp;lt;0.0001). No difference was observed in 10th, 50th, or 90th percentile LDL values when calculated by Sampson-NIH equation (56, 99, 153mg/dL); however, if the Friedwald formula is used, a slight shift is observed in the 10th and 50th percentile LDL values (54 vs. 53, 97 vs. 96; p&amp;lt;0.0001) but not the 90th (150mg/dL). Conclusions Changing to the Sampson/NIH formula for LDL-C and removing fasting vs. non-fasting designation from routine lipid panels had minimal effect on reported triglyceride and LDL-C values, while allowing increased flexibility in draw time and reporting of LDL-C on patients with triglycerides ≥400mg/dL. Patients with TG ≥400mg/dL represented 1.7% of the dataset overall, including 5,387 patients before the change in which LDL-C could not be reported and 6,697 patients in the year post-implementation for whom LDL-C was reported based on the Sampson-NIH formula. Using an equation that is robust in patients with elevated triglyceride levels and removing fasting requirements from routine lipid panels allows greater flexibility and convenience for patients while allowing for more even distribution of phlebotomy workload and reporting of LDL-C results for patients with hypertriglyceridemia without evidence of clinically significant bias in reported results.

A-073 Is there a relationship of FIB 4 with weight and insulin resistance in subjects without type 2 diabetes and with normal transaminases?

Abstract Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common hepatic disease, affecting 20-30% of the world's population, and is more frequent in subjects with cardiometabolic diseases. The Fibrosis-4 Index (FIB-4) is a non-invasive scoring system that helps estimate the risk of hepatic fibrosis in MASLD. It is based on age, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and platelets (PLT). MASLD is associated with high risk of insulin resistance (IR) and type 2 diabetes (DM2), and subjects with overweight or obesity are more likely to have both. In such cases the association of FIB-4 with IR and weight are evident. It is questioned whether, even in subjects without DM2 and with normal transaminases, FIB-4 could be associated with the body mass index (BMI) and the homeostasis model assessment of insulin resistance index HOMA-IR, which is the index usually used to assess IR. The objective of this study was to evaluate how FIB-4 would behave in subjects without DM2 and with normal transaminases and whether there was a correlation between FIB-4 with HOMA-IR and BMI in these subjects. Methods Authors studied the distribution of FIB-4 results and correlation of HOMA-IR and BMI with FIB-4 using the database of a clinical laboratory. We included patients aged 20-65 years, both gender, who measured fasting glucose and insulin, in the same visit, and transaminases and platelets within up to one year before or later. Were excluded hospitalized subjects, those using medications to treat DM2, dyslipidemia, subjects with blood glucose over 200 mg/dL, and AST and/or ALT above the reference range for gender and age. The methods and reference intervals were: transaminases: UVKinetic, AST &amp;lt; 40 U/L for men and &amp;lt; 32 U/L for women, ALT &amp;lt; 41 for men and &amp;lt; 33 for women; PLT: automated method, 150000-450000/µL. Glucose: hexokinase, 70 - 99 mg/dL; Insulin: electrochemiluminescence, 2-12 mcU/mL. HOMA-IR index was calculated using the equation: glucose (mg/dL) x insulin (mcIU/mL) / 405 and FIB-4 using the equation: age (years) × TGO (U/L) / [(platelets (µL) ÷1000) x √TGP (U/L))]. Shapiro Wilk test was performed to assess whether the analytes had normal distribution. To evaluate the correlation with HOMA-IR, Spearman's non-parametric correlation test was used. Results After applying the exclusion criteria and subtracting outliers 270,135 records were selected, 75% female, with 39,9 ± 10.1 years. As the parameters did not present Gaussian distribution, the results are shown in median and 25th and 75th percentiles: AST=18.9 (16-22); ALT=17.2 (13-23.3); PLT=266000 (229000-308000); glucose = 89.3 (84.2-95); insulin = 8.17 (5.52-12.8); HOMA-IR=1.81 (1.19-2.75); IMC=26.53 (23.80-29.91); FIB-4 = 0.65 (0.5 - 0.86). A weak and surprisingly negative correlation between HOMA-IR and BMI with FIB-4 was found. (HOMA-IR: r=- 0.2, p&amp;lt;0.001; BMI: r=- 0.1, p&amp;lt;0.01). Conclusions Our study showed that in a population with normal transaminases, FIB-4 had results compatible with low risk of fibrosis in subjects without DM2 even in cases with high HOMA-IR or BMI. The negative correlation was surprising and perhaps indicates that FIB-4 may not be a good predictor of liver fibrosis for this population profile.

IR Physician Compensation at U.S. Medical Schools: Trends and Segments

PurposeTo assess recent U.S. medical school trends in compensation for academic interventional radiology (IR) faculty and compensation characteristics based on rank, gender, and race/ethnicity. MethodsData for IR and diagnostic radiology (DR) faculty compensation were obtained from the Association of American Medical Colleges (AAMC), which annually surveys U.S. medical schools. IR faculty compensation data were analyzed from 2017 to 2023 with regard to rank, gender, and race/ethnicity and compared with DR faculty compensation. ResultsAAMC Faculty Salary Survey data for 2023 included responses for 874 IR faculty members, including 21 instructors, 457 assistant professors, 208 associate professors, 130 full professors, 42 chiefs, and 16 chairs. Median compensation increased by a rate of 5.0% per year for instructors and 3.0%–3.6% per year for all other ranks. Surveyed median and 25th and 75th percentile compensation for IR faculty were consistently greater than those of DR faculty at all ranks except chairs. From 2020 to 2023, this difference in compensation trended downward. Compensation for women was lower than men, with a gender pay difference of $35,000 (8.4%), $33,000 (7.5%), $26,000 (5.1%), and $32,000 (6.2%) for instructors, assistant, associate, and full professors, respectively, in 2023. In 2023, compared with White assistant professors, Asians made 94 cents, Black/African Americans made 97 cents, and Hispanic/Latinx/Spanish-origin physicians made 95 cents on the dollar, at the same rank. ConclusionsIR faculty compensation has barely kept pace with inflation over recent years, overall increasing with rank, and overall higher than for DR counterparts.

Academic Radiology Physician Financial Compensation in the United States: Trends and Distribution.

Background The overall trends in academic radiology physician compensation are not well studied. Purpose To assess recent trends in academic radiology financial compensation and distribution based on rank, gender, race/ethnicity, and geography in U.S. medical schools. Materials and Methods This secondary analysis used deidentified data from the Association of American Medical Colleges (AAMC) Faculty Salary Report, which collects information for full-time faculty at U.S. medical schools. Financial compensation data for full-time academic radiology faculty was collected from 2017 to 2023, stratified by rank, gender, race/ethnicity, and geography. The faculty salary report includes median, 25th, and 75th percentile compensation values for each rank, which were used to analyze trends with linear regression. Median compensation values were used to compare groups based on gender, race/ethnicity, and region. Results The AAMC Faculty Salary Report data for 2023 included responses for 5847 faculty members across all radiology departments, including 306 instructors, 2758 assistant professors, 1409 associate professors, 1004 full professors, 226 chiefs, and 144 chairs. On average, median faculty compensation increased by 2.6%-4.4% per year from 2017 to 2023, with the greatest increase (by 4.4% per year) at the instructor level and smaller increases (3.4%-2.6%) at the more senior ranks. Male faculty members were consistently compensated more than women at all ranks throughout the study period. The overall salary gap remained at 6% ($455 000 for women vs $483 000 for men) throughout the study period but increased numerically from $24 000 in 2019 to $28 000 in 2023. Black/African American faculty had a lower median compensation compared with White faculty (by 4% overall; $452 000 for Black/African American faculty vs $472 000 for White faculty) at all ranks except at professor rank. Instructor compensation in the Northeast region was substantially higher (by $278 000) than other regions, but this geographic differential did not exceed $35 000 at other ranks. Conclusion This study summarized the trends of full-time academic radiology faculty compensation and showed persistent salary inequities that should be addressed as part of a broader drive to increase diversity, equity, and inclusion. © RSNA, 2024 Supplemental material is available for this article.

Dairy farm management factors associated with auction sale price of young dairy calves sold at auction markets in Québec, Canada. A cross-sectional study

Each year around 150,000 surplus calves are sold at auction markets in Québec, Canada. Surplus calves (male or female not kept in the herd of origin) are sold at a young age, but these animals are at risk of receiving lower quality neonatal care than replacement heifers. Knowledge of factors associated with a higher selling price could help convince farmers to spend more resources in the care surplus calves. Our objective was to explore the associations between farm management practices and the median percentile of surplus calf selling price per farm at auction markets. The price (CAD/kg of body weight) and the individual identification number of surplus calves sold in 2 auction markets in Québec during 4 sales days in the summer 2019 and in the winter 2020 were recorded. The recorded price of each surplus calf was transformed as percentile for each breed and day of sale. Farmers managing the surplus calves were contacted and interviewed on farm management practices. The data from farmer's interviews were analyzed as potential variables associated with the median percentile of calves' selling price per farm (farm level dependent variable) in a multivariable linear regression model. A total of 509 farmers were contacted, of which 433 farmers agreed to participate, and 409 interviews were retained for statistical analysis. The farms enrolled in the study had sold a median of 2 calves (range 1-19 calves) during the sale days considered. The main breed of surplus calves sold were Holstein (82%) and Angus crossbred calves (9%). The results from the multivariable model showed that median percentile of calves' selling price was positively associated with farms with an average milk production per cow superior to 11,000 L/years (β 0.13, 95% confidence interval (95% CI): 0.045, 0.221) and farms with 3 or more workers available to take care of surplus calves (β 0.08, 95% CI: 0.005, 0.167). Those results indicate that farms having an average milk production per cow superior to 11,000 L/year increase the calves' selling price by 13 percentiles (i.e., from 50th to 63rd) and that farms having at least 3 caretakers increase their median percentile calves' selling price by 8 percentiles (i.e., from 50th to 58th). Median percentile of calves' selling price was negatively associated with farms that vaccinated cows for neonatal calf diarrhea (β -0.06, 95% CI:-0.127, -0.011), that do not disinfect the navel of newborn calves (β -0.07, 95% CI:-0.133, -0.012), that allow transporters to enter the farm's building (β -0.07, 95% CI:-0.130, -0.015) and that used wood shaving as bedding for surplus calves (β -0.08, 95% CI:-0.156, -0.021). Sensitivity analyses performed on farms that have sold 2 or more surplus calves did not show significant changes in the associations found. Despite the fact that the study was based on self-reported questionnaire answers and a small number of calves per farm, it provides insight on farm management practices associated with median percentile of surplus calf selling price at the auction markets. Taking these results in consideration, farmers could potentially improve the market value of their animals.

The impact of cohort inclusion/exclusion criteria on pregnancy weight gain chart percentiles.

Pregnancy weight gain standards are charts describing percentiles of weight gain among participants with no risk factors that could adversely affect weight gain. This detailed information is burdensome to collect. We investigated the extent to which exclusion of various pre-pregnancy, pregnancy and postpartum factors impacted the values of pregnancy weight gain percentiles. We examined pregnancy weight gain (kg) among 3178 participants of the US nuMoM2b-Heart Health Study (HHS). We identified five groups of potential exclusion criteria for pregnancy weight gain standards: socio-economic characteristics (group 1), maternal morbidities (group 2), lifestyle/behaviour factors (group 3), adverse neonatal outcomes (group 4) and longer-term adverse outcomes (group 5). We established the impact of different exclusion criteria by comparing the median, 25th and 75th percentiles of weight gain in the full cohort with the values after applying each of the five exclusion criteria groups. Differences > 0·75 kg were considered meaningful. Excluding participants with group 1, 2, 3 or 4 exclusion criteria had no impact on the 25th, median or 75th percentiles of pregnancy weight gain. Percentiles were only meaningfully different after excluding participants in group 5 (longer-term adverse outcomes), which shifted the upper end of the weight gain distribution to lower values (e.g. 75th percentile decreased from 19·6 kg to 17·8 kg). This shift was due to exclusion of participants with excess postpartum weight retention > 5 kg or > 10 kg. Except for excess postpartum weight retention, most potential exclusion criteria for pregnancy weight gain standards did not meaningfully impact chart percentiles.

Accessibility of neurotization in deep inferior epigastric perforator flap reconstruction: inequities and implications for pre-authorization.

Breast anesthesia and hypoesthesia occur commonly after mastectomy and negatively impact quality of life. Neurotization during deep inferior epigastric perforator (DIEP) breast reconstruction offers enhanced sensory recovery. However, access to neurotization for DIEP reconstruction patients has not been evaluated. This retrospective study included patients who underwent DIEP breast reconstruction between January 2021 and July 2022 at a tertiary-care, academic institution. Demographics, outcomes, insurance type, and Area Deprivation Index (ADI)were compared using two-sample t-test or Chi-square analysis. Of the 124 patients who met criteria, 41% had neurotization of their DIEP flaps. There was no difference in history of tobacco use (29% vs 33%), diabetes (14% vs 9.6%), operative time (9.43 hr vs 9.73 hr), length of hospital stay (3 d vs 3 d), hospital readmission (9.8% vs 6.8%), or reoperation (12% vs 12%) between to patients with and without neurotization. However, access to neurotization differed significantly by patient health insurance type. Patients who received neurotization had a lower median ADI percentile of 40.0 indicating higher socioeconomic advantage compared to patients who did not receive neurotization at 59.0 (p=0.01). Access to neurotization differed significantly by patient health insurance and by ADI percentile. Expanding insurance coverage to cover neurotization is needed to increase equitable access and enhance quality of life for patients who come from disadvantaged communities. Our institution's process for pre-authorization is outlined to enhance likelihood of insurance approval for neurotization.