Wide Variation Research Articles

Engagement with art and meaning in life: the predictive roles of awe, interest, supernatural attributions

ABSTRACT Drawing from Aesthetic Cognitivism, the position that art can lead to meaningful understandings, we predicted that people with more interest in art, experiences of awe around art, and supernatural attributions for art experiences would have higher levels of meaning in life. In Study 1, we tested these hypotheses in three samples (n = 100 in each sample) with varying art expertise. Results showed the strongest support for hypotheses in samples with varying levels of art training. In Study 2, in an online sample with wide variation in art training (N = 1,862), we found strong support for hypotheses. In both studies, multiple regressions including covariates (aesthetic fluency, religious belief salience) showed unique associations mainly for awe around art. Overall, our results were consistent with Aesthetic Cognitivism, providing a rare empirical test of this theory, and pointed to psychological experiences with art as potentially relevant to life meaning.

Trends in acrylamide content in selected potato/sweet potato products on the Canadian market

Processed plant-based foods, particularly high carbohydrate-containing foods, are among the greatest contributors to dietary acrylamide, a probable human carcinogen, uptake. Between 2009 and 2020, five surveys were conducted to determine acrylamide in high carbohydrate-containing foods in Canada. These surveys included sampling of potato and sweet potato chips, French fries, and frozen potato/sweet potato products, as a follow-up to our earlier surveys from 2002 - 2008. Samples were analyzed using isotope dilution (13C3-acrylamide) with LC-MS/MS. The highest mean acrylamide levels were found in sweet potato chips. Among potato chips (57 to 4660 ng g−1), one brand consistently showed the highest concentrations with wide variability. Acrylamide concentrations decreased over time in ready-to-eat French fries (from 480 to 358 ng g−1), and one brand showed a clear reduction temporally. Wide variations were observed among brands, among lots/outlets of same brands, and among different food chains. Acrylamide levels in potato chips decreased between 2009 and 2016 (504.3 ng g−1) relative to the period 2002 - 2008 (1096.9 ng g−1). The acrylamide trends observed in the products measured in the latest study indicate that food producers may have adopted mitigation strategies.

Spatio-temporal patterns of excess mortality from non-COVID causes of death in the United States, march-December 2020.

Objectives To estimate the burden of excess mortality from 17 underlying causes of death between March-December 2020 in the United States, and to compare trends in excess deaths from non-COVID causes vs. from COVID-19. Methods Using time series models, we estimated monthly counts of all-cause and cause-specific excess deaths. We stratified by geographic region and compared temporal trends in excess deaths from non-COVID causes to trends in deaths attributed to COVID-19. Results Of approximately 500,000 excess deaths, 70% were attributed to COVID-19. We observed increases in several underlying causes of death, ranging from a 3% increase in kidney disease deaths to a 24% increase in homicides, as well as decreases in deaths from cancer (-0.3%), influenza and pneumonia (-2%), chronic lower respiratory disease (-3%), and suicide (-7%). Trends in excess deaths from cardiovascular disease, diabetes, and Alzheimer's disease closely mirrored trends in deaths from COVID-19. Trends in excess liver disease, homicide, suicide, and motor vehicle accident deaths were negatively correlated with trends in deaths from COVID-19. There was wide regional variation in excess death rates for some causes of death, including a disproportionate increase in homicide and motor vehicle accident deaths in the Great Lakes, and a sustained reduction in cancer deaths in the Mideast and New England. Conclusions Increases in cardiovascular disease, diabetes, and Alzheimer's disease deaths from March-December 2020 likely reflect healthcare system disruptions or acute complications of COVID-19. Excess deaths from homicide and liver disease are more likely to reflect social and economic effects of the emerging pandemic, or other separate causes.

Measurement of the sodium and iodine scintillation quenching factors across multiple NaI(Tl) detectors to identify systematics

The amount of light produced by nuclear recoils in scintillating targets is strongly quenched compared to that produced by electrons. A precise understanding of the quenching factor is particularly interesting for weakly interacting massive particles (WIMP) searches and coherent elastic neutrino-nucleus scattering (CEνNS) measurements since both rely on nuclear recoils, whereas energy calibrations are more readily accessible from electron recoils. There is a wide variation among the current measurements of the quenching factor in sodium iodide (NaI) crystals, especially below 10 keV, the energy region of interest for dark matter and CEνNS studies. A better understanding of the quenching factor in NaI(Tl) is of particular interest for resolving the decades-old puzzle in the field of dark matter between the null results of most WIMP searches and the claim for dark matter detection by the DAMA/LIBRA collaboration. In this work, we measured sodium and iodine quenching factors for five small NaI(Tl) crystals grown with similar thallium concentrations and growth procedures. Unlike previous experiments, multiple crystals were tested, with measurements made in the same experimental setup to control systematic effects. The quenching factors agree in all crystals we investigated, and both sodium and iodine quenching factors are smaller than those reported by DAMA/LIBRA. The dominant systematic effect was due to the electron equivalent energy calibration originating from the nonproportional behavior of the NaI(Tl) light yield at lower energies, potentially the cause for the discrepancies among the previous measurements. Published by the American Physical Society 2024

Evaluation of the performance of digital x-ray systems in pelvis radiography

The aim of this study was to investigate the performance of eight digital radiography systems and to optimise the dose-image quality relationship for digital pelvis radiography. The study involved eight digital radiography systems used for general examinations at Vilnius University Hospital Santaros Klinikos. An anthropomorphic pelvic phantom (CIRS, US) was used to simulate a patient undergoing clinical pelvis radiography. Dose quantities entrance surface dose, dose area product (DAP) and exposure parameters (kVp, mA, mAs) were measured and the effects on the images were evaluated, considering physical contrast to noise ratio (CNR) and observer-based evaluations as image quality metrics. Increasing the tube voltage by 5 kVp from standard protocol led to a reduction in radiation dose (DAP) by 12%–20% with a slight impact on image quality (CNR decreases by 2%–10%). There was an inter-observer variability in image rating across different equipment (kappa value between 0 and 0.3); however, both observers agreed that increasing kVp up to 85–90 kV had no effect on perceived image quality. The results indicate that optimisation strategies should be tailored specifically for each x-ray system since significant performance differences and wide variations in radiation dose exist across various digital radiography systems used in clinical settings. The use of high kVp can be used for dose optimisation in digital pelvis radiography without compromising image diagnostic accuracy.

The cloak of equality in STEM education: institutionalised masking of gender differences in STEM expectations, task values, and participation

ABSTRACT Do gender parity and egalitarian values in STEM education mask institutionalised gender inequalities in STEM? This study uses student background questionnaire data from the 2015 Trends in International Mathematics and Science Study (TIMSS) supplemented by national level data on gender parity in educational enrolment and female participation in the STEM workforce from the United Nations and International Labor Organization to empirically examine the evidence. Using two-level hierarchical linear models, we analyse the effects of students’ STEM expectancies and task values on their anticipated STEM education and career participation. Results confirm that gender equity and egalitarian values dominate the cross-national expectancies and task values for STEM education, both across genders as well as for female and male students separately, even though there is wide variation and significant gendered inequality that persists in both educational access and STEM workforce participation. Thus, the ‘cloak of equality’ hypothesis is supported by the evidence presented.

The cloak of equality in STEM education: institutionalised masking of gender differences in STEM expectations, task values, and participation

ABSTRACT Do gender parity and egalitarian values in STEM education mask institutionalised gender inequalities in STEM? This study uses student background questionnaire data from the 2015 Trends in International Mathematics and Science Study (TIMSS) supplemented by national level data on gender parity in educational enrolment and female participation in the STEM workforce from the United Nations and International Labor Organization to empirically examine the evidence. Using two-level hierarchical linear models, we analyse the effects of students’ STEM expectancies and task values on their anticipated STEM education and career participation. Results confirm that gender equity and egalitarian values dominate the cross-national expectancies and task values for STEM education, both across genders as well as for female and male students separately, even though there is wide variation and significant gendered inequality that persists in both educational access and STEM workforce participation. Thus, the ‘cloak of equality’ hypothesis is supported by the evidence presented.

Obciążenie państw Afryki Subsaharyjskiej związane z niedokrwiennym udarem mózgu na podstawie wskaźnika DALY – analiza tendencji oraz identyfikacja czynników ryzyka

BackgroundStroke burden, measured by DALYs, reveals a growing concern in sub-Saharan Africa. Ischemic stroke, exacerbated by modifiable risk factors like hypertension and household air pollution, poses a significant health challenge. Regional disparities, economic development, and healthcare inefficiencies underscore the need for targeted interventions and further research.ObjectiveThis study aims to analyze trends in the burden of ischemic stroke across specific regions in sub-Saharan Africa from 2000 to 2019. The objective is to identify key changes in stroke burden progression and highlight modifiable risk factors.Material and methodsUtilizing World Health Organization (WHO) data from 2000 and 2019, national estimates of ischemic stroke DALYs in 49 sub-Saharan African countries were collected. DALYs were calculated per 100,000 population to reduce the impact of population size. Statistical analyses and visual representations using MapChart were employed to interpret the trends.ResultsThe study reveals wide variations in ischemic stroke DALYs changes across sub-Saharan African countries from 2000 to 2019. Predominantly, countries in the Eastern and Southern regions experienced adverse increases, while those in the Central and West regions mostly exhibited declines in DALYs. Countries such as Lesotho, Zimbabwe, and Mauritius, saw the most significant DALYs increases, whereas Rwanda, Malawi, and Equatorial Guinea experienced the most favorable changes.ConclusionsStroke is a pressing health concern in sub-Saharan Africa. Modifiable risk factors like hypertension and household air pollution necessitate targeted interventions. Tailored healthcare policies, reinforced health systems and comprehensive research into region-specific risk factors are crucial to alleviate stroke-related morbidity and mortality in the region. Addressing these challenges is vital to mitigate the increasing burden of stroke in the particular regions of sub-Saharan Africa.

Trends and Influencing Factors in Problematic Smartphone Use Prevalence (2012-2022): A Systematic Review and Meta-Analysis.

Given that problematic smartphone use (PSU) has been researched for a long time, it becomes necessary to assess how the trends of PSU prevalence have evolved over time. In total, 106 articles from 2012 to 2022 with 109 studies covering 97,748 individuals were included in this systematic review and meta-analysis. The estimation of the global pooled PSU prevalence was 37.1% (95% confidence interval, 33.5 - 40.8%) and the PSU prevalence is growing over time in total. Although the PSU prevalence exhibited wide variation between regions and measurement scales, the increasing trend remained. In addition, the regression slope of the PSU prevalence trend in males was higher than that in females. Males initially had a lower prevalence of PSU than females, but this steadily changed over time until it was greater in males than in females. Moreover, the prevalence of PSU showed an increasing trend across all age groups, with a faster growth rate in the older age group. Considering the aforementioned results, it's necessary to implement proper interventions to do with this phenomenon. In addition, considering the differences in prevalence brought by regions, and measurement scales, in practice and research, we should not only take into account the disparities of PSU between countries or cultures, but also to concern about establishing unified standard and measurement tools to confirm it.

Obciążenie państw Afryki Subsaharyjskiej związane z niedokrwiennym udarem mózgu na podstawie wskaźnika DALY – analiza tendencji oraz identyfikacja czynników ryzyka

BackgroundStroke burden, measured by DALYs, reveals a growing concern in sub-Saharan Africa. Ischemic stroke, exacerbated by modifiable risk factors like hypertension and household air pollution, poses a significant health challenge. Regional disparities, economic development, and healthcare inefficiencies underscore the need for targeted interventions and further research.ObjectiveThis study aims to analyze trends in the burden of ischemic stroke across specific regions in sub-Saharan Africa from 2000 to 2019. The objective is to identify key changes in stroke burden progression and highlight modifiable risk factors.Material and methodsUtilizing World Health Organization (WHO) data from 2000 and 2019, national estimates of ischemic stroke DALYs in 49 sub-Saharan African countries were collected. DALYs were calculated per 100,000 population to reduce the impact of population size. Statistical analyses and visual representations using MapChart were employed to interpret the trends.ResultsThe study reveals wide variations in ischemic stroke DALYs changes across sub-Saharan African countries from 2000 to 2019. Predominantly, countries in the Eastern and Southern regions experienced adverse increases, while those in the Central and West regions mostly exhibited declines in DALYs. Countries such as Lesotho, Zimbabwe, and Mauritius, saw the most significant DALYs increases, whereas Rwanda, Malawi, and Equatorial Guinea experienced the most favorable changes.ConclusionsStroke is a pressing health concern in sub-Saharan Africa. Modifiable risk factors like hypertension and household air pollution necessitate targeted interventions. Tailored healthcare policies, reinforced health systems and comprehensive research into region-specific risk factors are crucial to alleviate stroke-related morbidity and mortality in the region. Addressing these challenges is vital to mitigate the increasing burden of stroke in the particular regions of sub-Saharan Africa.

Resource utilisation and trophic niche overlap of coralline intertidal benthic amphipods: an isotopic perspective.

Benthic amphipod feeding groups are a well-established trophic classification that is mostly based on field observations and laboratory tests and are used in ecological studies to monitor the ecological state of benthic ecosystems. Globally, carbon and nitrogen stable isotope ratio investigations have provided confirmation of, and novel insights into, the trophic ecology of benthic animals, such as polychaetes. However, stable isotopic examinations of benthic amphipods have been limited. Here, we used microgram samples to compare the species-specific dietary sources, trophic positions, and isotopic niche overlap of selected benthic amphipods from the Gulf of Kachchh, Marine National Park, using elemental analyser-isotopic ratio mass spectrometry (EA-IRMS) of carbon and nitrogen. Overall, all primary carbon sources presented wide variation in the isotopic values of δ13C (6.3‰) and δ15N (greater than 13‰). Conversely, the amphipod taxa displayed relatively narrow range for δ13C (3.9‰) and wider range for δ15N (more than 10‰). The results of the Bayesian mixing model revealed that the benthic amphipods had species-specific feeding preferences. However, the predominant carbon source was organic matter in sediment which reinforced benthic pathways for energy flow for most species. According to the estimated trophic level values (1.62-3.39), these species play a significant role as primary and secondary consumers serving as crucial trophic intermediaries in the food chain, connecting the base to the top consumers. High overlapping ecological niche amongst species was detected by SIBER analysis which indicated co-existence of the benthic amphipods in their respective microhabitats. This signifies wider utilisation of resources and inter-specific feeding preferences with minimal competition amongst amphipod species.

Coronary artery event-free or resilient familial hypercholesterolemia: what's in a name?

Familial hypercholesterolemia (FH) is an autosomal semi-dominant condition, characterized by excessive circulating low-density lipoprotein cholesterol (LDL-C) from birth that substantially accelerates the onset and progression of atherosclerotic cardiovascular disease (ASCVD), classically coronary artery disease (CAD). Elevated plasma LDL-C integrated over time is unequivocally the major determinant of ASCVD in heterozygous FH (HeFH); however, the wide variation in incidence and progression of ASCVD suggests a role for a wide spectrum of risk modifiers. We reviewed recent evidence describing the features of an ASCVD-free entity referred to as resilient FH among patients with HeFH. Compared with nonresilient FH patients, resilient patients are more likely to be female, and have a lower prevalence of ASCVD comorbidities, higher levels of HDL-C and larger HDL particles, as well as a lower level of lipoprotein(a). A lower SAFEHEART risk score is also an independent predictor of resilient FH. Gene expression studies also demonstrate that resilient FH patients are associated with a less atherogenic gene expression profile in relation to HDL metabolism and immune responses, as reflected by higher expression of ABCA1 and ABCG1, and lower expression of STAT2 and STAT3, respectively. A group of HeFH patients, referred as resilient FH, can survive to advance ages without experiencing any ASCVD events. Several key contributors to the event-fee CAD in HeFH patients have been identified. This could not only improve risk stratification and management for FH but also be of major importance for the general population in primary and secondary prevention. However, resilient FH remains an under-investigated area and requires further research.

Commercial markups on pediatric oncology drugs at 340B pediatric hospitals.

Eligible pediatric hospitals can purchase clinician-administered drugs at discounted rates through the 340B Drug Pricing Program and charge payers prices exceeding drug acquisition costs, but the magnitude of these markups is not known. In a study of newly approved oncology drugs at pediatric 340B hospitals, median negotiated prices ranged from 102% (interquartile range [IQR]: 91%-156%) of average sales price (ASP) at Phoenix Children's Hospital to 630% (IQR: 526%-630%) at Driscoll Children's Hospital. Pediatric hospitals participating in the federal 340B Drug Pricing Program can extract steep payments on new drugs from commercial insurers, though with wide variation between and within hospitals.

Harnessing Artificial Intelligence to Predict Ovarian Stimulation Outcomes in In Vitro Fertilization: Scoping Review.

In the realm of in vitro fertilization (IVF), artificial intelligence (AI) models serve as invaluable tools for clinicians, offering predictive insights into ovarian stimulation outcomes. Predicting and understanding a patient's response to ovarian stimulation can help in personalizing doses of drugs, preventing adverse outcomes (eg, hyperstimulation), and improving the likelihood of successful fertilization and pregnancy. Given the pivotal role of accurate predictions in IVF procedures, it becomes important to investigate the landscape of AI models that are being used to predict the outcomes of ovarian stimulation. The objective of this review is to comprehensively examine the literature to explore the characteristics of AI models used for predicting ovarian stimulation outcomes in the context of IVF. A total of 6 electronic databases were searched for peer-reviewed literature published before August 2023, using the concepts of IVF and AI, along with their related terms. Records were independently screened by 2 reviewers against the eligibility criteria. The extracted data were then consolidated and presented through narrative synthesis. Upon reviewing 1348 articles, 30 met the predetermined inclusion criteria. The literature primarily focused on the number of oocytes retrieved as the main predicted outcome. Microscopy images stood out as the primary ground truth reference. The reviewed studies also highlighted that the most frequently adopted stimulation protocol was the gonadotropin-releasing hormone (GnRH) antagonist. In terms of using trigger medication, human chorionic gonadotropin (hCG) was the most commonly selected option. Among the machine learning techniques, the favored choice was the support vector machine. As for the validation of AI algorithms, the hold-out cross-validation method was the most prevalent. The area under the curve was highlighted as the primary evaluation metric. The literature exhibited a wide variation in the number of features used for AI algorithm development, ranging from 2 to 28,054 features. Data were mostly sourced from patient demographics, followed by laboratory data, specifically hormonal levels. Notably, the vast majority of studies were restricted to a single infertility clinic and exclusively relied on nonpublic data sets. These insights highlight an urgent need to diversify data sources and explore varied AI techniques for improved prediction accuracy and generalizability of AI models for the prediction of ovarian stimulation outcomes. Future research should prioritize multiclinic collaborations and consider leveraging public data sets, aiming for more precise AI-driven predictions that ultimately boost patient care and IVF success rates.

O-122 ICMART Preliminary World Report 2020

Abstract Abstract title: International Committee for Monitoring Assisted Reproductive Technologies (ICMART) Preliminary World Report on ART, 2020 Study question In 2020 what was the global utilization, effectiveness and safety of ART? Summary answer Globally, ART utilization and data collection continue to increase but with wide variations in utilization, effectiveness and safety. What is known already ICMART has continuously monitored utilization, effectiveness and safety since 1991, with increasing number of cycles, higher pregnancy rates and lower multiple birth rates, the latter due to the transfer of fewer embryos. Frozen embryo transfer (FET), donor egg cycles and preimplantation genetic testing (PGT) continue to increase. Wide variations in practice and outcomes exist globally. At least 12 million ART babies have been born. ICMART has helped develop registries internationally. A new electronic data collection platform has improved validation. Nevertheless, data collection and quality remain challenging. Study design, size, duration Countries and regions annually collect ART data, some prospectively and others retrospectively. ICMART retrospectively requested data from all known global sources for 2020, reviewed them for missing or incorrect data, and obtained additional information when possible. The corrected dataset was validated and analyzed in partnership with University of New South Wales (UNSW). ICMART finalized the results tables. Standardized definitions and previously developed methods were used. Preliminary results are presented. Participants/Materials, setting, methods The European IVF Monitoring Consortium (EIM), Latin American Network of Assisted Reproduction (REDLARA), Australian/ New Zealand Registry and African Network and Registry for ART (ANARA) submitted regional data, and other countries contributed national data, through standardized formats, to ICMART. A few individual clinics with no registry access also contributed. Data received were reviewed, corrected, and validated to the extent possible, analyzed and summarized by ICMART using descriptive statistics. Main results and the role of chance Data collection and analysis are ongoing, so the presented results are preliminary. The number of ART cycles continues to increase, but utilization remains highly variable among countries and regions. While historically Europe has reported the largest number of cycles, China now reports well over 1 million cycles and Japan almost half a million, with Asia overall reporting approximately half of global cycles. Regional and country differences persist in the age of women treated, number of embryos transferred, live birth rates, rate of multiple births, use of ICSI and cryopreservation, and other factors. Covid reduced ART utilization in many countries. The role of chance is minimal. Data are limited to reporting countries and clinics, representing 90 to 95% of global cycles. However, this is a very large sample size from which imputation of total global results is performed. Limitations, reasons for caution Most, but not all, countries report to ICMART. Some countries have limited data and many countries have limited data validation. ICMART can perform only minimal verification of submitted data. Widespread adherence to consensus definitions provided in the Glossary takes time and requires translation into multiple languages. Standardization of validation and reporting is an ongoing process because of missing data and continuing changes in clinical practice. Wider implications of the findings ICMART World Reports standardize data, track trends, enable comparisons, stimulate questions and improve ART quality. Better understanding of ART increases societal acceptance and support for equitable access and ART research.

P-330 The impact of adenomyosis on pregnancy outcomes, from conception to birth- a systematic review and meta-analysis

Abstract Study question What is the impact of adenomyosis and its phenotypes on spectrum of outcomes ranging from conception to birth? Summary answer Adenomyosis has a negative impact on implantation with reduced clinical pregnancy and live birth rate and increased risk of miscarriage and perinatal morbidity. What is known already Current evidence, including meta-analyses, on the impact of adenomyosis on reproductive outcomes is conflicting. There are data suggesting that adenomyosis has a negative impact on pregnancy outcomes whereas some studies have suggested that adenomyosis appears inert, with no impact on reproductive functions. A wide variation has been observed in the baseline population, type of Assisted Reproductive Technology (ART) stimulation protocol, number, order and type of ART cycles across the pooled observational studies. Alongside, there may be a spectrum of adenomyosis characteristics like the disease type, location, severity, and presence of coexisting endometriosis, resulting in heterogeneity and our interpretation of evidence. Study design, size, duration For this systematic review and meta-analysis, a comprehensive search was conducted in MEDLINE, EMBASE, CINAHL Plus, Web of Science Core Collection, Clinicaltrials.gov and WHO ICTRP from inception until January 2024 with no language restriction. Observational studies were included with participants as women with natural and/or medically assisted reproduction (MAR) conception, exposure as adenomyosis diagnosed on imaging, histology or using WHO International Classification of Disease 10th edition (ICD-10) code (N80.0) and comparator as women without adenomyosis. Participants/materials, setting, methods Data was included from 51 observational studies for the meta-analysis of pregnancy and obstetric outcomes. ROBINS-E tool (Risk Of Bias In Non-randomized Studies-of Exposure) was be used to assess the risk of bias. Odds ratio (OR) from individual studies were pooled using random-effects model to summarise the estimate for dichotomous outcomes with 95% confidence interval (CI) and mean differences for continuous outcomes. This was supplemented by sensitivity analyses. Clinical heterogeneity was assessed with I² statistics. Main results and the role of chance Women with adenomyosis had reduced odds of implantation (OR = 0.78; CI: 0.72-0.86), lower clinical pregnancy (OR = 0.87; CI: 0.82-0.92), higher miscarriage (OR = 1.51; CI: 1.44-1.58), and lower live birth (OR = 0.56; CI: 0.50-0.63) compared to those without. Both, diffuse and focal adenomyosis were associated with lower live birth (OR = 0.56; CI: 0.45-0.72; diffuse and OR = 0.56; CI: 0.45-0.70; focal). The miscarriage risk was higher in junctional zone adenomyosis (OR = 4.04; CI: 1.17-13.94) compared to outer myometrium adenomyosis. The negative impact of adenomyosis was evident in subgroups of women undergoing donor oocyte cycles (OR = 0.62; CI: 0.50-0.76; live birth and OR = 1.83; CI: 1.26-2.66; miscarriage) and first ART cycle (OR = 0.55; CI: 0.48-0.65; live birth and OR = 2.16 CI: 1.72-2.71; miscarriage). Conversely, those with euploid embryo transfer, had a higher odds of miscarriage (OR = 1.90; CI:1.05-3.43) with no significant impact on live birth (OR = 0.78; CI: 0.52-1.19). The impact continued perinatally, including pre-eclampsia (OR = 1.32; CI: 1.23-1.41), small for gestational age (OR = 1.323; CI:1.25-1.40), placenta previa (OR = 3.99, CI: 3.53-4.51), caesarean section (OR = 1.97; CI:1.89-2.05), and low Apgar scores (OR = 0.911; CI:0.88-0.96). Limitations, reasons for caution The inherent heterogeneity among the included observational studies was high; however, subgroup analyses for type of ART cycle, number, and order of ART cycle and by phenotype of adenomyosis had low heterogeneity. This warrants caution when interpreting pooled outcome estimates for pregnancy and obstetric outcomes across general population of women. Wider implications of the findings Adenomyosis has a direct and negative impact on fertility and pregnancy outcomes by virtue of impaired implantation and trophoblastic function. Hence, adenomyosis needs to be factored in when counselling women about the success of MAR cycles and requires closer monitoring in pregnancy as a high-risk pregnancy. Trial registration number not applicable

1112 Breast Cancer After Breast Augmentation (BCABA): A National Multicentre Collaborative Study of Patient Management and Outcomes

Abstract Aim The incidence of breast cancers diagnosed in patients that have previously had cosmetic breast augmentation is increasing. The presence of an implant at diagnosis poses management challenges. The largest UK series to date reports 49 patients from the iBRA study. We aimed to establish current UK practice encompassing both breast conserving surgery (BCS) and mastectomy +/- reconstruction, and its safety profile. Method A national multicentre collaborative model was used, with a steering committee from the NWBRC. Women diagnosed with breast cancer (invasive or non-invasive) from 2012 onwards with pre-existing implant augmentation were identified and data was recorded on REDCapâ. Outcomes were pathology and imaging findings, surgery performed, complications, and recommended adjuvant treatments. Recruitment will end in January 2024. Results An interim analysis representing 80% study accrual to date was performed. 24 collaborators from 23 UK units participated, identifying 144 women (median age 51 years, IQR 44-58). 124(86%) presented symptomatically and 20(14%) via screening. 103(72%) underwent BCS with 23(22%) requiring further excision. 84(82%) retained an implant and 98% of these patients were recommended for adjuvant radiotherapy. 41(28%) had mastectomy; 22(54%) had reconstruction (21 implant-based reconstruction, 1 autologous). Of the entire cohort, 6 patients returned to theatre within 90 days for a complication, and 3 lost an implant. Conclusions This is the largest reported series of these patients worldwide. There are wide variations in standard of care. Early analysis suggests that re-excision rates for patients undergoing BCS may be higher in this group. Complication rates are comparable to national standards.

Trends and Factors Associated With Peripheral Vascular Interventions for the Treatment of Claudication From 2011 to 2022: A National Medicare Cohort Study.

Previous cross-sectional studies have identified wide practice pattern variations in the use of peripheral vascular interventions (PVIs) for the treatment of claudication. However, there are limited data on longitudinal practice patterns. We aimed to describe the temporal trends and charges associated with PVI use for claudication over the past 12 years in the United States. We conducted a retrospective analysis using 100% Medicare fee-for-service claims data to identify all patients who underwent a PVI for claudication between January 2011 and December 2022. We evaluated the trends in utilizationand Medicare-allowed charges of PVI according to anatomic level, procedure type, and intervention settings using generalized linear models. Multinomial logistic regressions were used to evaluate factors associated with different levels and types of PVI. We identified 599 197 PVIs performed for claudication. The proportional use of tibial PVI increased 1.0% per year, and atherectomy increased by 1.6% per year over the study period. The proportion of PVIs performed in ambulatory surgical centers/office-based laboratories grew at 4% per year from 12.4% in 2011 to 55.7% in 2022. Total Medicare-allowed charges increased by $11 980 035 USD/year. Multinomial logistic regression identified significant associations between race and ethnicity and treatment setting with use of both atherectomy and tibial PVI. The use of tibial PVI and atherectomy for the treatment of claudication has increased dramatically in in ambulatory surgical center/office-based laboratory settings, non-White patients, and resulting in a significant increase in health care charges. There is a critical need to improve the delivery of value-based care for the treatment of claudication.

Assessment of spatio-temporal characteristics of groundwater quality at Khordha District, India

Groundwater is the major basis for drinking in various parts of our country. However, it gets contaminated by the toxic materials found in rocks, because of which it becomes unfit for various domestic and irrigation purposes. In present study, the groundwater quality and its availability for various purposes were examined by the parameters such as pH, DO, EC, TDS, temperature, salinity, Alkalinity, Total hardness, calcium hardness, magnesium hardness, chloride, fluoride, nitrate and phosphate during the post monsoonseason of 2022 and pre monsoon season of 2023 from 49 sampling locations. The above mentioned parameters were used for assessing appropriateness of groundwater for irrigation and domestic purposes by comparing them with the Bureau of Indian standards (BIS). The results revealed that groundwater shows wide variations among various parameters between two seasons during 2022–23. Obtained results show that water used for potable purposes by people in various parts of study area doesn’t meet necessary standards.In some of the sampling locations, it is found that the water exhibits very poor quality or unfit maybe for one season or both seasons. Analysis of parameters is done for calculating correlation coefficient of specified parameters. Strong linear relationships, both positive and negative, were found between several pairs of water quality measures according to their research.

P-648 How often does elevated progesterone occur? A systematic review

Abstract Study question What is the incidence of elevated serum progesterone level during the follicular phase in fresh and frozen ART cycles? Summary answer The incidence of elevated progesterone levels varies widely during the follicular phase in both fresh and frozen ART cycles. What is known already Progesterone monitoring is often performed for the optimization of ART cycle. Elevated progesterone (EP) noted during ovarian stimulation can lead to cycle cancellation and the implementation of a freeze all strategy as EP is associated with lower pregnancy rates. The introduction of GnRH analogues did not seem to prevent EP. In frozen embryo transfer (FET) cycles, EP can be present even without gonadotropin commencement. Various thresholds have been used to define EP and the incidence of EP reported in the literature varies. Study design, size, duration A systematic search of the following electronic databases: EMBASE, MEDLINE, CINAHL and PubMed identified non-randomised comparative cohort studies between the year 2000 to 2022. The following keywords progesterone, assisted reproductive technique and pregnancy outcomes and their respective variants were used. Study selection was performed following initial screen of the titles and abstracts. The full manuscripts were examined for compliance with the inclusion criteria and studies eligible for inclusion in the review were selected. Participants/materials, setting, methods PICOS study protocol was used. We included studies reporting per woman data of women undergoing fresh IVF/ICSI cycles (with controlled ovarian stimulation) and FET cycles (natural or medicated), with extractable data on pregnancy outcomes and using serum progesterone monitoring. We excluded interventional studies and studies involving oocyte or gamete donation. Comparisons were made between the population with EP versus non-elevated progesterone in fresh and FET cycles. Main results and the role of chance We included 52 studies (N = 53,517 women) for the systematic review. In fresh COS cycles, the incidence of EP at baseline varied from 13.3% to 30% (30% in P > 0.65ng/ml; 13.3% - 23.2% in P > 1.5ng/ml). At ovulation trigger, the incidence of EP ranged from 3.1% to 65%. (33% - 52.2% in P > 0.9ng/ml; 20% - 65% in P > 1.0ng/ml; 13.9% - 31.2% in P > 1.1ng/ml; 17.2% - 54.7% in P > 1.2ng/ml; 21.5% - 32.7% in P > 1.3ng/ml; 4.6% - 44.2% in P > 1.5ng/ml; 7% - 20.1% in P > 1.7ng/ml; 11.9% in P > 1.9ng/ml and 3.1% - 33.6% in P > 2.0ng/ml). The incidence of EP at egg collection ranged from 27.3% to 55.4%. (55.4% in P > 2.0ng/ml; 39.4% in P > 11.7ng/ml and 27.3% in P > 12ng/ml). In frozen cycles, the incidence of elevated progesterone was 68.7% at ovulation trigger in modified natural cycle FET (NC-FET). The incidence of EP before ovulation in NC-FET was 24.4% (P > 1.0ng/ml) and 26.4% (P > 1.57ng/ml). Limitations, reasons for caution Observational studies were included in this systematic review with wide variation of progesterone thresholds and timing that increases the clinical heterogeneity. The incidence of EP varies widely among the included studies. The immunoassays used for progesterone measurement were not standardised with questionable accuracy at low levels. Wider implications of the findings The incidence of EP varies significantly amongst the studies. We observed similar wide variation of EP incidence at low and high progesterone threshold level. The accuracy of immunoassays on progesterone concentrations <2.5ng/ml has been questioned and the non-standardized timing of progesterone measurement challenges the reliability of the measured progesterone result. Trial registration number not applicable