Differences Research Articles

Use of a Refined Theory for Three-Dimensional Bending Analysis of Isotropic Rectangular Thick Plates

In this paper, a refined plate theory (Alternative II theory) is presented for the three-dimensional bending analysis of an Isotropic thick plate. The theory has similarity to the first order shear deformation theory but requires no shear correction factors. The kinematics equations were developed based on the Alternative II Refined plate theory. Thereafter, using a complete three-dimensional constitutive relation, the total potential energy was developed. A governing equation and two compatibility equations were obtained by the variation of the total potential energy with respect to displacement and rotations respectively. Solving the governing and compatibility equations, a polynomial displacement function was obtained. The stiffness coefficients were then obtained using the displacement function. Thereafter, the equations for the in-plane normal and shear stresses, transverse normal and shear stresses as well as the lateral displacement were developed using the stiffness coefficients and the displacement function. Numerical values of the lateral displacement parameters were determined for a rectangular plate of aspect ratio 2.0, 1.0 and 0.5 for span to thickness ratios of 20, 10 and 7.14286. Also, numerical values of the lateral displacement and stresses were determined for a square plate for span to thickness ratios of 4, 10, 100 and 1000. The results from this work were compared with the work of previous researchers using simple percentage difference. It was observed that refined plate theories overestimate the lateral displacement of a plate. Hence, three-dimensional analysis is recommended for thick plate analysis.

The Performance of Continuous Glucose Monitoring During the Intraoperative Period: A Scoping Review.

Introduction: Perioperative dysglycemia is associated with negative surgical outcomes, including increased risk of infections and longer hospital stays. Continuous glucose monitoring (CGM) provides real-time glucose data, potentially improving glycemic control during surgery. However, the performance of CGM in the intraoperative environment has not been well established. This scoping review aimed to evaluate the performance of CGM systems during the intraoperative period, focusing on their technical reliability, accuracy, adverse device effects, and efficacy. Inclusion criteria: Studies that assessed intraoperative CGM performance, focusing on technical reliability, accuracy, adverse effects, or efficacy, were included. No restrictions were placed on the study design, surgical type, participant demographics, or publication date. Methods: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, covering publications up to 12 June 2024. Two independent reviewers screened and selected the studies for inclusion based on predefined eligibility criteria. Data extraction focused on the study characteristics, CGM performance, and outcomes. Results: Twenty-two studies were included, the majority of which were prospective cohort studies. CGM systems demonstrated a high technical reliability, with sensor survival rates above 80%. However, the accuracy varied, with some studies reporting mean or median absolute relative differences of over 15%. The adverse effects were minimal and mainly involved minor skin irritation. One randomized trial found no significant difference between CGM and point-of-care glucose monitoring for glycemic control. Conclusions: Although CGM has the potential to improve intraoperative glycemic management, its accuracy remains inconsistent. Future research should explore newer CGM technologies and assess their impact on surgical outcomes.

Trends in Marijuana Use among Adolescents in the United States.

Marijuana is a widely used substance in the United States (US) and worldwide. We explored trends in self-reported marijuana use among US adolescents overall as well as by gender, race/ethnicity, and school grade. Biennial data from the Youth Risk Behavior Survey from 2011 to 2021 included 88,183 adolescents in grades 9th through 12th. We used percentage change as a measure of effect and the chi-square test for significance. All analyses were conducted at the national level. The percentage of adolescents who reported current marijuana use dropped significantly from 23.1% in 2011 to 15.8% in 2021 (p < 0.05). The self-report of trying marijuana for the first time before age 13 also decreased significantly from 8.1% in 2011 to 4.9% in 2021 (p < 0.05). For current use, there were similar significant decreases by race/ethnicity, with Asian, Hispanic, and White adolescents experiencing the steepest declines. In 2021, the percentage of Black adolescents self-reporting marijuana use was significantly higher (20.5%) compared to White (14.8%), Hispanic (16.7%), and Asian (5.1%) adolescents. Although current marijuana use declined significantly for both girls and boys over time, in 2021 girls were more likely (17.8%) to currently use marijuana than boys (13.6%). In 2011, the opposite was true, with boys (25.9%) being more likely to use marijuana than girls (20.1%). In US adolescents in 2021, there were decreases in self-reports of marijuana use compared to 2011. Behavioral interventions within school and family environments may be critical in mitigating the risk of marijuana use.

The effect of consuming a sucrose-containing sports drink on acute kidney injury risk during a four-hour simulated occupational heat stress.

Occupational heat stress increases acute kidney injury risk. Drinking a soft drink sweetened with high fructose corn syrup further elevates this acute kidney injury risk. However, the impact of sucrose, another fructose containing-sweetener, on acute kidney injury risk remains unexplored. We tested the hypothesis that drinking a sucrose-containing sports drink increases acute kidney injury risk when compared to drinking a sugar-free sports drink during four hours of simulated occupational heat stress. Ten healthy adults consumed a sucrose-containing or sugar-free sport drink ad libitum during four-hour exposures to wet bulb globe temperatures of ~28°C. 30 min of work and 30 min of rest were completed each hour. Work involved treadmill walking at a fixed rate of metabolic heat production (sucrose-containing: 6.0±1.2 W/kg, sugar-free: 5.5±0.9 W/kg, p=0.267). The product of urinary insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinase-2, normalized to urine specific gravity ([IGFBP7·TIMP-2]USG), provided an acute kidney injury risk index. Mean core (intestinal: n=13, rectal: n=7) temperature (sucrose-containing: 37.5±0.1°C, sugar-free: 37.5±0.3 °C; p=0.914), peak core temperature (sucrose-containing: 37.8±0.2°C, sugar-free: 37.9±0.3 °C; p=0.398), and percent changes in body mass (sucrose-containing: -0.5±0.4%, sugar-free: -0.3±0.6%; p=0.386) did not differ between groups. [IGFBP7∙TIMP-2]USG increased in both groups (time effect: p=0.0254) with no drink (p=0.675) or interaction (p=0.715) effects. Peak change [IGFBP7∙TIMP-2]USG did not differ between sucrose-containing (median 0.0116 [-0.0012, 0.1760] (ng/mL)²/1000) and sugar-free (median 0.0021 [0.0003, 0.2077] (ng/mL)²/1000; p=0.796). Sucrose-containing sports drink consumption during simulated occupational heat stress does not modify acute kidney injury risk when compared to sugar free-sport drink consumption.

Micro-Coring: A Novel Approach to Perioral Rejuvenation.

A long philtrum and poor perioral skin quality are stigmata of the aging face. Micro-Coring is a novel technology that allows for scarless skin removal. In this study we aimed to determine whether micro-coring can shorten the philtrum and improve perioral skin quality. A retrospective cohort study was performed on patients who underwent facelift with perioral micro-coring and age- and BMI-matched controls who underwent facelift alone. Preoperative and postoperative 3-dimensional facial imaging was performed. Standard perioral distances and percentage of change were calculated. Perioral skin quality was evaluated by blinded raters with the Scientific Assessment Scale of Skin Quality (SASSQ) and Global Aesthetic Improvement Scale (GAIS). Thirteen patients and 13 controls were included, with a mean follow-up of 8.9 months (range 3.0-21.5). Patients had significantly shorter mean philtrum length postoperatively compared to preoperatively, with an average decrease of 6.18% (±2.25%; P < .05). Controls did not experience significant changes in philtrum length (P > .05). There were no significant changes in other perioral measurements. Perioral skin elasticity and wrinkles significantly improved in patients compared to controls and patients had significantly greater GAIS scores (P < .05). Micro-Coring can achieve perioral rejuvenation through measurable shortening of the philtrum and observable improvement in skin quality. Nonsurgical techniques continue to find new ways to achieve aesthetic goals without significant recovery or scarring and offer value to patients and clinicians.

Geographical disparities in temporal trends of low birth weight in Saskatchewan from 2002/2003 to 2021/2022: insights from a joinpoint regression analysis.

Low birth weight (LBW) is an important public health indicator that is associated with various negative health outcomes in infants. To effectively implement interventions that would improve health outcomes in children, it is important to understand both the historical trends and current levels of LBW rates. In this study, trends and regional differences in LBW rates in Saskatchewan from 2002/2003 to 2021/2022 were assessed. A joinpoint regression analysis was conducted using historical LBW rates, obtained from the Canadian Institute for Health Information database. Data were analysed using average percent change and average annual percent change. Spatial patterns and trends were identified using a choropleth map. From a provincial and national rate of 5.2% in 2002/2003, the LBW rate in Saskatchewan increased to 6.5% in 2021/2022, approaching the national rate of 6.8%. Over the 20-year period, average annual changes for Canada were 1.4% and 1.0% for Saskatchewan. There was a turning point in the study: 2004/2005 for Canada and 2011/2012 for Saskatchewan. Initially, Saskatchewan had stable LBW rates, increasing yearly by 0.1%, while the national rate was 5.7%. However, in recent years, Saskatchewan's rate increased to 1.8% annually, surpassing the national rate of 0.9%. Geographical differences were also observed within Saskatchewan, with the Far North region having the highest LBW rate (9.2%), and the Central West region having the lowest rate (4.3%) in 2021/2022. The Central East, Regina Qu'Appelle, and southern Saskatchewan saw significant upwards trends in LBW rates between 2015/2016 and 2021/2022. There is an increasing trend in LBW rates in Canada and Saskatchewan, as well as geographical disparities within the province. The geographical disparities in LBW rates underscore the need for tailored interventions in high-risk regions in the province.

Short- and long-term stability of synovial fluid calprotectin.

Information about analyte stability is of crucial importance. The aims of this study were to determine the short- and long-term stability of synovial fluid calprotectin at various temperature conditions (4-8 °C for 7 days, - 20 °C and - 80 °C for 6 weeks). Eleven samples from patients were included in this study. The samples were promptly transported at room temperature (RT) to the laboratory immediately after arthrocentesis. Upon arrival, the samples were transferred into plastic tubes without additives and pretreated with hyaluronidase solution. After centrifugation at 1500xg for 10 minutes at RT, the baseline calprotectin concentrations were determined. Seven aliquots were stored in LoBind tubes (Eppendorf) at 4-8 °C and the calprotectin was measured every day. Six additional aliquots were stored at temperatures - 20 °C and - 80 °C and the concentration of calprotectin was measured weekly. Analysis was done using Buhlmann fCAL turbo reagent on analyzer Siemens Atellica Solution (Siemens Healthcare, Erlangen, Germany). Data were analyzed by Microsoft Excel and MedCalc statistical software. The percentage difference (PD%) was calculated. The maximum permissible difference (MPD) was 9.1% for PD%. The PD% with the corresponding 95% confidence intervals were inside the predefined MPD. The instability equations and correlation coefficient for storage temperatures were PD% = 0.1644 x time (day), r = 0.06, P = 0.614 for 4-8°C, PD% = 0.5190 x time (week), r = - 0.22, P = 0.080 for - 20°C, and PD% = 0.1316 x time (week), r = 0.08, P = 0.545 for - 80°C. The calprotectin in the synovial fluid is stable when stored long-term for 6 weeks at - 20 °C or at - 80 °C or short-term (7 days) at 4-8 °C.

Pneumonia-Related Hospitalizations among the Elderly: A Retrospective Study in Northeast Italy.

Background: In both the elderly and children, pneumonia remains one of the leading causes of hospitalization. This study aimed to assess the impact of pneumonia-related hospitalizations in the population over 65 years of age in the Veneto Region. Methods: This retrospective study analyzed hospital discharge records for patients aged 65 and older who resided in the Veneto Region and had a diagnosis of pneumonia from 2007 to 2023. The hospitalizations were identified using specific ICD-9-CM codes for pneumonia as a discharge diagnosis. Hospitalization rates, mortality rates, the prevalence of complications and comorbidities, the length of stay, and associated costs were calculated by age and year. Results: From 2007 to 2023, there were 139,201 hospitalizations for pneumonia. Emergency admissions accounted for 92.1% of these cases, and only 2.0% had a specific diagnosis of pneumococcal pneumonia. The median length of stay was 10 days, and the median diagnosis-related group (DRG) tariff per hospitalization was EUR 3307. Excluding the pandemic years, the hospitalization rates remained stable at approximately 850 cases per 100,000 inhabitants before 2019. After 2022, the rates started to increase again. Overall, in the investigated period, the results showed a negative trend (average Annual Percentage Change (AAPC) of -1.931, p < 0.0001). However, when only considering the pre-pandemic years, the trend was stable, while a decline was observed starting in 2020 (AAPC of -19.697, p = 0.001). The overall discharge mortality rates ranged from 13% to 19.3% but were significantly higher in those over 85 years of age (20.6% compared with 6.5% and 12.0% in the 65-74 and 75-84 age groups, respectively). Conclusions: This study highlights the substantial burden of pneumonia in individuals over 65 years of age, showing the impacts on public health.

Temporal trend of the global prevalence rate of tension-type headache in children and adolescents in 1990-2021

To investigate the prevalence of tension-type headache (TTH) in children and adolescents aged 0-19 years globally in 1990-2021, and to provide a basis for the prevention and treatment of TTH. Based on the Global Burden of Disease Study data, the age-standardized prevalence distribution of TTH and its changing trend were analyzed among the children and adolescents aged 0-19 years, with different sexes, age groups, sociodemographic index (SDI) regions and countries/territories. The age-standardized prevalence rate (ASPR) of TTH in children and adolescents aged 0-19 globally in 2021 was 17 339.89/100 000, which was increased by 1.73% since 1990. The ASPR in females was slightly higher than that in males (1990: 17 707.65/100 000 vs 16 403.78/100 000; 2021: 17 946.29/100 000 vs 16 763.09/100 000). The ASPR in adolescence was significantly higher than that in school-aged and preschool periods (1990: 27 672.04/100 000 vs 10 134.16/100 000; 2021: 28 239.04/100 000 vs 10 059.39/100 000). Regions with high SDI exhibited a higher ASPR than the other regions, with significant differences in prevalence rates across different countries. From 1990 to 2021, there was a slight increase in global ASPR, with an average annual percentage change (AAPC) of 0.06%. Females experienced a smaller increase than males based on AAPC (0.04% vs 0.07%). There was reduction in ASPR in preschool and school-aged groups, with an AAPC of -0.02%, while there was a significant increase in ASPR in adolescence, with an AAPC of 0.07%. ASPR decreased in regions with low-middle and low levels of SDI, with an AAPC of -0.02% and -0.04%, respectively, while it increased in regions with middle SDI, with an AAPC of 0.24%. There is a consistent increase in the ASPR of TTH in children and adolescents aged 0-19 years globally, with significant differences across sexes, age groups, SDI regions and countries/territories.

Estimation of burden of cancer incidence and mortality in India: based on global burden of disease study 1990–2021

BackgroundCancer poses a significant public health challenge in India, making it crucial to predict its future impact for effective healthcare planning. This study forecast cancer incidence, mortality, and disability-adjusted life years (DALYs) in India from 2022 to 2031.MethodsWe extracted age-standardized data on incidence, prevalence, DALYs, and mortality from 1990 to 2021 from the Global Burden of Disease (GBD) study. We used Decadal Average Percentage Change techniques to identify trends in cancer burden over decades and the Autoregressive Integrated Moving Average (ARIMA) method were used for forecasting. The ARIMA (2,2,2) model was identified as the best for predicting cancer incidence, ARIMA (0,3,3) for DALYs, and ARIMA (0,2,2) for mortality.ResultsThe cancer incidence rate is expected to rise from 529.40 (95% CI: 525.41-533.38) in 2022 to 549.17 (95% CI: 487.43-610.92) per 100,000 population in 2031. The DALYs rate is projected to decrease from 2001.53 (95% CI: 1964.24-2038.82) in 2022 to 1842.08 (95% CI: 1273.57-2410.60) per 100,000 population in 2031, indicating improvements in cancer burden management. Mortality rates are forecasted to increase slightly, from 71.52 (95% CI: 69.91–73.12) in 2022 to 73.00 (95% CI: 60.88–85.11) per 100,000 population in 2031. Overall, while incidence and mortality rates show a slight upward trend, the DALYs rate is projected to decrease, reflecting potential advancements in cancer management and treatment over the forecast period.ConclusionsOver the next decade, cancer incidence and mortality are expected to increase in India, highlighting the need for enhanced prevention, early detection, and proper treatment strategies. Despite these increases, the anticipated decrease in DALYs suggests potential advancements in cancer management, warranting further investigation into the drivers of this positive trend and measures to sustain it.

The Decline of Medicare Reimbursement in Anatomic Pathology

Abstract Introduction/Objective Lack of an annual inflationary update for physician reimbursement from the Centers for Medicare &amp; Medicaid Services (CMS) jeopardizes access to anatomic pathology services at healthcare institutions nationwide. The effects of recent inflationary trends on anatomic pathology physician reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2004 to 2024 for anatomic pathology procedures. Methods/Case Report The Physician Fee Schedule Look-Up Tool from the CMS was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the Consumer Price Index and reported in 2024 US dollars. The average annual and total percent change in reimbursement were calculated for included procedures. The compound annual growth rate (CAGR) was calculated using 2024 and 2000 inflation-adjusted monetary data. Results (if a Case Study enter NA) Prior to adjusting for inflation, the average physician reimbursement increased by 9.7% from 2004 to 2024 for all included anatomic pathology CPT codes. After adjusting for inflation, the average physician reimbursement decreased by 34.2% for included CPT codes. The greatest decrease in reimbursement observed from 2004 to 2024 was for outside slide consultation at 60.5% ($330.12 to $130.49), followed by pathology consultation during surgery at 59.0% ($83.54 to $34.29). The average CAGR was -2.19%. Conclusion Our study demonstrates that Medicare physician reimbursement for common anatomic pathology procedures is declining annually at an unsustainable rate. This downward trend necessitates policy action to prevent access barriers to quality anatomic pathology care nationwide, especially for Medicare beneficiaries.

The Decline of Medicare Reimbursement in Clinical Pathology

Abstract Introduction/Objective Access to clinical pathology services nationwide is threatened by the lack of an annual inflationary update for physician reimbursement from the Centers for Medicare &amp; Medicaid Services (CMS). Most recently, the 2024 Medicare Physician Fee Schedule (MPFS) implemented an overall 2.0% reduction in pathology reimbursement. The effects of recent inflationary trends on clinical pathology physician reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2004 to 2024 for clinical pathology procedures. Methods/Case Report The Physician Fee Schedule Look-Up Tool from the CMS was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the Consumer Price Index and reported in 2024 US dollars. The average annual and total percent change in reimbursement were calculated for included procedures. A subset analysis was conducted to assess physician pathology clinical consultation services average annual and total percent change in reimbursement pre- and post- 2022 MPFS Update. The compound annual growth rate (CAGR) was calculated using 2024 and 2000 inflation- adjusted monetary data. Results (if a Case Study enter NA) Prior to adjusting for inflation, the average physician reimbursement decreased by 6.8% from 2004 to 2024 for included clinical pathology CPT codes. After adjusting for inflation, the average physician reimbursement decreased by 44.0% for included CPT codes. The greatest decrease in reimbursement observed from 2004 to 2024 was for flow cytometry interpretation, 2-8 minutes at 69.5% ($114.44 to $34.95) followed by flow cytometry interpretation, 9-15 minutes at 57.8% ($142.77 to $60.25) and flow cytometry interpretation, &amp;gt;16 minutes at 56.6% ($188.05 to $81.55). The average CAGR was -2.86%. Prior to adjusting for inflation, the average physician reimbursement for clinical pathology consultation services pre-2022 decreased by 0.9%, and when adjusted for inflation, decreased by 30.0%. Post-2022 MPFS revision, the average physician reimbursement for clinical pathology consultation services decreased by 3.5%, and when adjusted for inflation, decreased by 12.2%. The average CAGR pre-2022 was -2.0% and post-2022 was -4.3%. Conclusion Medicare physician reimbursement for common clinical pathology procedures is decreasing at an untenable rate annually. It is critical that policymakers understand these trends to ensure continued access to quality clinical pathology care at healthcare institutions.

Buffy coat removal to mitigate reporting false normal G6PD phenotype results in patients undergoing rasburicase therapy for tumor lysis syndrome

Abstract Glucose-6-phosphate dehydrogenase (G6PD) is the primary source of NADPH in red blood cells (RBCs). NADPH reduces reactive oxygen species (ROS) thereby protecting RBCs from oxidative stress-mediated hemolytic anemia (HA). Individuals with partial or full G6PD deficiency are therefore susceptible to acute HA provoked by medications that generate high ROS loads in vivo, e.g., rasburicase. Rasburicase is an enzyme-based therapeutic used to degrade uric acid (UA) in patients with tumor lysis syndrome (TLS); however, catalysis of UA generates H2O2, a potent ROS, which poses a risk of HA in individuals who are deficient in G6PD activity. Screening G6PD activity prior to rasburicase administration is clinically indicated in ethnic groups with high rates of G6PD deficiency, although reports of HA in rasburicase-treated patients have been reported across low prevalence ethnic groups as well. TLS occurs most commonly during the treatment of highly proliferative neoplasms, such as leukemia and lymphoma. Since WBCs contain significant G6PD activity, an elevated WBC count in these patients can cause the false assurance of low HA risk due to a falsely normal G6PD activity. We sought to establish and evaluate a novel method to mitigate WBC contamination of G6PD measurements in patients undergoing rasburicase therapy. In this study, we first developed and validated an innovative method (“piercing method”) to minimize the interference of WBCs in G6PD measurements. The piercing method demonstrated acceptable accuracy (slope: 1.008; bias: -6.22%) and precision (1.4% CV between 9.9 to 20.7 U/g Hb) and was effective at eliminating a broad range of WBC types and concentrations from whole blood samples (N = 85, tested range = 0.31 – 413.05 K/μL, 93% reduction in WBCs). We compared G6PD activity in rasburicase-treated patients (N = 39) with varying WBC counts before and after buffy coat removal using the piercing method. Average percent change in G6PD activity (post-pierce – pre-pierce) between patients with and without elevated WBCs was substantial (45% versus 12%). In comparing G6PD activity in patients before and after the initiation of rasburicase therapy, there is no evidence that in vivo-generated ROS from rasburicase affect G6PD measurement in vitro in an assay that relies on monitoring absorbance of NADPH (22.2 U/g Hb versus 22.9 U/g Hb, p=0.721). Results demonstrate how WBCs increase risk for false elevation in G6PD activity in patients being considered for rasburicase therapy. At greatest risk are patients with partial G6PD deficiency, e.g., heterozygous females, where G6PD from WBCs could mask deficiency. Literature describing testing of G6PD in specimens with elevated WBCs is lacking. This study shows that the piercing method provides accurate G6PD results in samples with elevated WBCs from patients at risk of TLS, who might develop HA after starting rasburicase therapy.

Does the Imbalance of ESG Activities Affect Company Performance? -- Evidence from Chinese A-share Listed Companies from 2018-2022

In recent years, the concept of sustainable development has progressively gained traction among the populace, with the performance of enterprises in environmental, social, and corporate governance (ESG) aspects attracting widespread attention from various sectors of society. The weighting of E, S, and G components varies across domestic and international ESG rating agencies, often resulting in significantly divergent weighted ESG scores. Leveraging the theory of organizational ambidexterity, this paper empirically investigates the impact of discrepancies between institutional ESG scores and equally weighted ESG scores on company performance, utilizing a sample of Chinese A-share listed companies spanning the years 2018 to 2022. Our findings reveal that equally weighted ESG scores exhibit a correlation with company performance, and a higher positive percentage difference between a company's rating agency ESG scores and its equally weighted ESG scores is associated with lower performance. This suggests that the rating agency weighting method may inadvertently encourage companies to engage in "greenwashing." This conclusion remains consistent after conducting robustness tests. Heterogeneity analysis further indicates that the negative impact of this difference on company performance is more pronounced among non-state-owned companies, manufacturing companies, and small companies. The mechanism of action test reveals that this difference negatively affects company performance by exacerbating financing constraints and reducing operating efficiency.

Video head impulse gain is impaired in myotonic dystrophy types 1 and 2.

This study was undertaken to examine vestibulo-ocular reflex (VOR) characteristics in myotonic dystrophy type 1 (DM1) and type 2 (DM2) using video head impulse testing (vHIT). VOR gain, refixation saccade prevalence, first saccade amplitude, onset latency, peak velocity, and duration were compared in DM1, DM2, age-matched normal controls, and patients with peripheral and central vestibulopathies. Fifty percent of DM1 and 37.5% of DM2 patients demonstrated reduced VOR gain. Refixation saccade prevalence for horizontal canal (HC) and posterior canal (PC) was significantly higher in DM1 (101 ± 42%, 82 ± 47%) and DM2 (70 ± 45%, 61 ± 38%) compared to controls (40 ± 28% and 43 ± 33%, p < 0.05). The first saccade amplitudes and peak velocities were higher in HC and PC planes in DM1 and DM2 compared to controls (p < 0.05). HC slow phase eye velocity profiles in DM1 showed delayed peaks. The asymmetry ratio, which represents the percentage difference between the first and second halves of the slow phase eye velocity response, was therefore negative (-22.5 ± 17%, -2.3 ± 16%, and - 4.7 ± 8% in DM1, DM2, and controls). HC VOR gains were lower and gain asymmetry ratio was larger and negative in patients with DM1 with moderate to severe ptosis and a history of imbalance and falls compared to the remaining DM1 patients (p < 0.05). In peripheral vestibulopathies, saccade amplitude was larger, peak velocity was higher, and onset latency was shorter (p < 0.05) than in DM1. In central vestibulopathy (posterior circulation strokes), saccade peak velocity was higher, but amplitude and onset latency were not significantly different from DM1. VOR impairment is common in DM1 and DM2. In DM1, refixation saccade characteristics are closer to central than peripheral vestibulopathies. Delayed peaks in the vHIT eye velocity profile observed in patients with DM1 may reflect extraocular muscle weakness. VOR impairment and VOR asymmetry in DM1 are associated with imbalance and falls.

Layperson-Administered Naloxone Trends Reported in Emergency Medical Service Activations, 2020-2022

Layperson-administered naloxone (LAN) is a powerful but incompletely characterized intervention to prevent opioid-related overdose mortality. LAN trends are relevant to policy and strategic planning in naloxone distribution initiatives. To assess the 2-year LAN trend for persons in the United States receiving naloxone during emergency medical services (EMS) activations. This retrospective cross-sectional study was conducted in the United States from June 2020 to June 2022 among 65 621 195 EMS activations from 911 responses, EMS standbys, or when EMS crews functioned in an ambulance intercept role or during mutual aid to another ambulance response. Activations within health care settings and interfacility or medical transports were excluded. Data are from the National Emergency Medical Services Information System (NEMSIS), the national EMS patient care record database. From June 2020 to June 2022, NEMSIS included more than 96 million EMS activations from nearly 14 000 agencies across 54 states and territories. EMS clinician-reported LAN. The primary outcome was the trend of receiving LAN, measured by EMS clinician documentation. From June 2020 to June 2022, EMS reported 744 078 patients receiving naloxone, with 24 990 (3.4%) involving LAN. Patients were predominantly male (17 331 [69.4%]) and had a median (IQR) age of 42 (31-56) years, with the majority treated in urban homes or residences (21 692 [86.8%] urban; 13 223 [52.9%] in-home or residence). Of the total naloxone recipients, 243 985 patients (32.8%) had suspected drug overdose documentation as either the primary or secondary impression. Overall, the percentage change in naloxone administration rates decreased 6.1% over the study period (from 1140.1 [95% CI, 1135.1-1145.1] per 100 000 EMS activations to 1070.1 [95% CI, 1064.9-1075.3] per 100 000 EMS activations), while the percentage change of persons receiving LAN increased 43.5% (from 30.0 [95% CI, 29.2-30.8] per 100 000 EMS activations to 43.1 [95% CI, 42.0-44.1] per 100 000 EMS activations). In this cross-sectional study, the LAN rate increased from June 2020 to June 2022 as reported in the national EMS database. These findings help inform policies and practices aimed at mitigating the devastating impacts of the opioid epidemic and saving lives. Novel public health strategies are needed to measure the effects of this intervention nationally, evaluate approaches to expand naloxone distribution, and address naloxone usage barriers.

Recovery From COVID-19–Related Disruptions in Cancer Detection

The COVID-19 pandemic impacted the timely diagnosis of cancer, which persisted as the second leading cause of death in the US throughout the pandemic. To evaluate the disruption and potential recovery in cancer detection during the first (2020) and second (2021) years of the COVID-19 pandemic. This cross-sectional study involved an epidemiologic analysis of nationally representative, population-based cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program. Included patients were diagnosed with incident cancer from January 1, 2000, through December 31, 2021. The analysis was conducted in May 2024 using the April 2024 SEER data release, which includes incidence data through December 31, 2021. Diagnosis of cancer during the first 2 years of the COVID-19 pandemic (2020, 2021). Difference between the expected and observed cancer incidence in 2020 compared with 2021, with additional analyses by demographic subgroups (sex, race and ethnicity, and age group) and community (county-level) characteristics. The analysis included 15 831 912 patients diagnosed with invasive cancer between 2000 and 2021, including 759 810 patients in 2020 and 825 645 in 2021. The median age was 65 years (IQR, 56-75 years), and 51.0% were male. The percentage difference between the expected and observed cancer incidence was -8.6% (95% CI, -9.1% to -8.1%) in 2020, with no significant difference in 2021 (-0.2%; 95% CI, -0.7% to 0.4%). These translated to a cumulative (2020-2021) deficit in observed vs expected cases of -127 931 (95% CI, -139 206 to -116 655). Subgroup analyses revealed that incidence rates remained substantially depressed from expected rates into 2021 for patients living in the most rural counties (-4.9%; 95% CI, -6.7% to -3.1%). The cancer sites with the largest cumulative deficit in observed vs expected cases included lung and bronchus (-24 940 cases; 95% CI, -28 936 to -20 944 cases), prostate (-14 104 cases; 95% CI, -27 472 to -736 cases), and melanoma (-10 274 cases; 95% CI, -12 825 to -7724 cases). This cross-sectional study of nationally representative registry data found that cancer incidence recovered meaningfully in 2021 following substantial disruptions in 2020. However, incidence rates need to recover further to address the substantial number of patients with undiagnosed cancer during the pandemic.

Physically-based modelling of UK river flows under climate change

This study presents the model setup and results from the first calibrated, physically-based, spatially-distributed hydrological modelling of combined land cover and climate change impacts on a large sample of UK river catchments. The SHETRAN hydrological model was automatically calibrated for 698 UK catchments then driven by the 12 regional climate model projections from UKCP18, combined with urban development and natural flood management scenarios. The automatic calibration of SHETRAN produces a median Nash-Sutcliffe efficiency value of 0.82 with 581 catchments having a value greater than 0.7. 24 summary metrics were calculated to capture changes to important aspects of the flow regime. The UKCP18 realisations in SHETRAN indicate that a warming climate will cause river flows, on average, to decrease. These decreases are simulated to be greatest in the south and east of the UK, with droughts becoming longer and more severe. While high flows also decrease on average, an increased number of extremes are exhibited, implying a greater number of extreme flood events in the future, particularly in the north and west of the UK. In the urban development scenarios, for flood events there is an increase in flow with the increased urbanization, with the 1 in 3-year peak flow event showing the greatest increase. The natural flood management scenarios consider the effect of increasing woodland and adding surface water storage ponds. The inclusion of these features produces a complex response but overall, the modelling shows a reduction in low, median, and high flows, although the more extreme the flow event the smaller the percentage change in flow. Simulated timeseries and summary metric datasets are freely available on the CEDA archive.

Cerebral Vasomotor Reactivity to Carbon Dioxide Using the Rebreathe Technique: Assessment of Within-day and Between-day Repeatability.

The cerebral vasodilator response to increased arterial carbon dioxide (CO2) concentration, termed cerebral vasomotor reactivity (CVMR), is used to assess cerebral vascular function. We sought to assess the within-day and between-day repeatability of CVMR to rebreathing-induced hypercapnia. Twelve healthy adults performed a within-day short interval protocol (17±2 minutes between trials), ten performed a within-day long interval protocol (145±16 minutes between trials), and seventeen performed a between-day protocol (5±2 days between visits). Repeatability of the slope of the percent change in middle cerebral artery mean blood velocity (%MCAvmean) and cerebral vascular conductance index (%CVCi), to the change in partial pressure of end-tidal CO2 (PETCO2) between the two trials/days was assessed. Within-day short interval %MCAvmean slope demonstrated fair to excellent repeatability (intraclass correlation, ICC=0.92 [95% confidence interval 0.72-0.98]; p<0.001) while %CVCi slope showed more variability (ICC=0.84 [0.47-0.95]; p=0.002]). Within-day long interval, %MCAvmean (ICC=0.95 [0.80-0.99]) and %CVCi (ICC=0.94 [0.71-0.99]) slopes showed good to excellent and fair to excellent repeatability respectively (p<0.001 for both). For between-day trials, better repeatability was observed for %CVCi (ICC=0.85 [0.57-0.95]; p<0.001) compared to %MCAvmean (ICC=0.76 [0.33-0.91]; p=0.004) slope. These findings indicate repeatable within- and between-day CVMR responses to rebreathe induced hypercapnia. However, a longer interval may be better for within-day repeat trials, particularly for CVCi measures.

Patterns of decomposition and functional traits for flower and leaf litter in tropical woody species.

The variation within and across species has afterlife effects on carbon and nutrient cycling through the alteration of litter decomposability. However, the focus on leaves may not reflect a whole-plant economic spectrum of strategies. Here, we assessed the patterns and predictors of flower and leaf-litter decomposition at the intra- (i.e., flowers and leaves of the same species) and inter-specific (i.e., flowers and leaves from different species) levels for 29 tropical woody species in northeast Brazil. We evaluated nine functional litter traits, including structural and chemical traits. Flower litter decomposed, on average, three times faster than leaf litter (11.9% and 39.4% mass remaining, respectively) and exhibited higher water-holding capacity (WHC), leaching (LEA), and N, P, and K content. Otherwise, leaf litter showed higher density (DEN) and Ca, Mg, and Na content. The average relative differences in decomposition rate and functional traits between flower and leaf litter did not differ at both intra- and inter-specific levels. The predictors of decomposition were mostly similar, explaining 39% and 37% of flower and leaf litter, respectively. Leaching, P, Ca, Mg, and Na predict both flower and leaf-litter decomposition. However, WHC exclusively predicted flower-litter decomposition, and DEN, N, and K exclusively predicted leaf-litter decomposition. The observed differences in decomposition rate and functional traits between flower and leaf litter indicate that the afterlife effects differ between these plant organs and leverage the role of flower litter and its secondary consequences to nutrient and carbon cycling on ecosystems.