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OBJECTIVE Olfaction influences nutrition, safety, and the cognitive development of children. Presently there are few olfactory tests for children, and normative reference values are generally lacking. In this study, we validate the Pediatric Smell Wheel® (PSW) to evaluate olfactory function in Brazilian children. METHODS We modified and validated the PSW, a test developed in the United States, for administration in Brazil, and established normative data for Brazilian children. The validation process consisted of five phases: First, we identified odorants familiar to Brazilian children. Second, we established the test-retest reliability of the Brazilian PSW test that employed these odorants. Third, we compared the test scores of healthy children to those microsmic from adenoid hypertrophy. Fourth, we examined the test's ability to detect improvement in olfactory function before and after adenoidectomy. Finally, we determined a normative 10th percentile cut point for defining microsmia in a sample of 169 healthy Brazilian children between 5 and 12 years of age. RESULTS Eleven odors were identified for inclusion in the test. The test-retest reliability was modest (r = 0.54, p

Statement of problem Studies evaluating the accuracy of edentulous arch impressions encompassing conventional and digital methods are lacking. Purpose The purpose of this in vitro study was to evaluate 8 impression-making methods for edentulous arches and to determine the effects of using a 3-dimensionally printed polyetheretherketone (PEEK) scanning aid on the accuracy of intraoral scanners. Material and methods Three sets of edentulous arch typodonts were scanned with an industrial scanner as a reference. Subsequently, a scanning aid for the edentulous arch was individually designed on each reference scan dataset by using a 3-dimensional modeling software program and fabricated in PEEK with a 3-dimensional printer. Each typodont was scanned with 2 intraoral scanners 12 times, with and without the assistance of a scanning aid for the edentulous arch. Impressions were made with 4 different conventional impression materials (irreversible hydrocolloid, polysulfide, polyether, and polyvinyl siloxane)—12 times for each typodont—the casts were poured and digitized with a tabletop scanner. Each scan data set was superimposed over the corresponding scan data set, and the original and absolute distance values from the paired surface points were obtained to measure the trueness and precision. These were expressed by using the mean, median, root mean square, and (90 percentile-10 percentile)/2 of the absolute distance value (NMT) concepts, based on the raw data extraction protocol. A repeated-measures ANOVA followed by a post hoc Bonferroni test was conducted (α=.05). Results The impression-making methods did not show statistically significant differences (P>.05) for either trueness or precision, particularly when the median values of the original and absolute distance values from the paired surface points were chosen as the standard values. One of the intraoral scanners used exhibited significantly superior outcomes to conventional impression materials when scanned with the scanning aid for the edentulous arch for both trueness and precision when the mean, root mean square, and NMT concepts were applied (P Conclusions Intraoral scanners demonstrated accuracy comparable with that of conventional impression materials for making edentulous arch impressions, regardless of the concepts used to express the trueness and precision. The PEEK-based scanning aid for the edentulous arch did not improve the accuracy of the intraoral scanners; however, its application resulted in higher accuracy compared with that of conventional impression materials.

Objective To examine whether patterns of body mass index (BMI) percentile gains across childhood predict BMI percentile, overweight and obesity, waist circumference, and elevated or prehypertensive blood pressure at age 15. Methods Trained technicians in the Study of Early Child Care and Youth Development assessed children's weight and height from birth to 15 years and waist circumference and blood pressure at age 15 (n = 1,132). Children's BMI percentile trajectories from age 2 to age 13 along with 28 demographic and social covariates were used to predict BMI percentile, waist circumference, overweight, obesity, and elevated or prehypertensive blood pressure. Linear and logistic regressions were used to predict BMI percentile, overweight, obesity, waist circumference, and elevated or prehypertensive blood pressure. Results Children were classified into one of four BMI percentile trajectories: "low stable" (28.4%), "low-to-high" (11.8%), "median stable" (29.0%), and "high rising" (30.7%). Children in trajectory classes characterized by persistent above average BMI percentile or by periods of rapid BMI percentile gains were more likely than their peers to experience poor weight and elevated or prehypertensive outcomes in adolescence. Trajectory class membership explained substantially more variance in adolescent health outcomes than demographic covariates alone. Estimated maternal BMI was a key independent predictor of adolescent outcomes. Conclusions Different patterns of BMI percentile gains, namely those with rapid gains or persistently above average BMI percentile, from ages 2-13 predicted weight, waist circumference, and elevated or prehypertensive blood pressure at age 15, above and beyond demographic and social characteristics.

Objective The main objective of this study was to obtain percentile curves of stereoacuity in arc seconds for a Spanish population aged between three and twelve years of age. Materials and methods A descriptive, observational and transversal study was conducted, which included children aged between three and twelve years of age who did not present with any known ocular and/or systemic diseases. The convenience sampling method was used to select the sample from three schools and one hospital in the Community of Madrid. The Bueno-Matilla Vision Unit's random dot test was used to measure stereoacuity. A descriptive statistic was performed with the stereoacuity values that were obtained for the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles. Results The stereoacuity values of 1300 children were analysed. In the 50th percentile curve, it was determined that stereoacuity values close to 40 sec/arc were present from four years of age, and at four years and nine months, stereoacuity values close to 28 sec/arc were already being observed within said percentile, with values that were similar to those expected in the adult population. A progressive increase was observed, reaching 19 sec/arc before six years of age, with this stereoacuity value becoming more established in children from seven years of age. Conclusion Although given the specific type of sampling that was performed it was not possible to generalise the results to the entire population, these percentile curves may aid paediatric professionals in their assessment of the development of this visual ability, which is indicative of the degree of development of binocular vision.

Background Previous studies suggest that PAP-based CF protocols are suitable for newborn screening (NBS) for cystic fibrosis (CF) when newborns designated as CFSPID should not be detected. However, there are still discussions about the performance of IRT/PAP algorithms. We present the final results of a pilot study evaluating a IRT/PAP protocol with an IRT-dependent safety net (SN) conducted from 2008 to 2016 in southwestern Germany on nearly 500,000 newborns. Methods To achieve reliable data, all newborns were screened using both the PAP-based and a DNA-based CFNBS algorithm. PAP quantification and genetic analysis of the four most common CFTR mutations in Germany were performed in all newborns with IRT≥99.0 percentile. NBS was rated positive if either PAP was ≥1.6 µg/l and/or at least one CFTR mutation was detected. In addition, an IRT-dependent SN resulted in positive rating for both protocols if IRT was ≥99.9 percentile. To evaluate the IRT/PAP protocol, its performance was compared to that of the IRT/DNA protocol. Results The IRT/PAP protocol with IRT-based SN used in the study achieved a sensitivity of 94%, if false-negative detected neonates with meconium ileus and those designated as CFSPID were excluded from analysis. CF/CFSPID ratio was 92. However, PPV of the IRT/PAP+SN protocol was with 10.3% very low. Conclusions PAP-based CFNBS protocols can be used, if less detection of CFSPID is desired. The IRT/PAP protocol with IRT-dependent SN evaluated here achieved adequate sensitivity but should probably be used in combination with a third-tier test to also achieve an acceptable PPV.

Objectives To systematically evaluates the evidence on ethnic differences in age-adjusted reference values of PSA. Materials and Methods In concordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement, a review of English articles using Medline, Embase and Cochrane databases, from inception to December 2019 was conducted. Studies that reported the PSA upper reference value as 95th percentile of the cohort distribution, in healthy men aged 40 – 79, were included. Methodological quality was assessed with a modified version of the Agency for Healthcare Research and Quality checklist for cross-sectional studies. Results Forty-three studies examining 325,514 participants were included in the analysis. These were published between 1993 - 2018. Majority were prospective observational studies and reported the reference values in ten-year age intervals. Only five reports directly compared ethnic differences in PSA values. Due to missing data, six studies were not considered in the quantitative synthesis. For the remainder (37/43), heterogeneity in PSA reference values was considerable (Higgin's index = 99.2%), with age and ethnicity being the sole identified significant contributors. Accordingly, the pooled upper limits for PSA reference values were 2.1, 3.2, 4.9 and 6.5 ng/ml for men in their 40s, 50s, 60s, and 70s, respectively. Conclusions Moderate quality evidence suggest that upper PSA reference limits increased with age and significant ethnic differences were present.

Background & aims Upper levels of normal for alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyltransferase (GGT) generally take sex into account, but not age. This simplification may lead to misclassification and burden the patient and health system unnecessarily. Methods Consecutive blood samples were analyzed from a German laboratory. Subcohorts included samples from a prescribed routine check-up and a healthy cohort, defined as patients without increased GGT, triglyceride, cholesterol, glycated hemoglobin, or glucose levels, and without known hepatitis B. Results A total of 1,369,180 blood samples were analyzed from 601,779 participants (50.8% female; mean age, 58.5 y; SD, 18.0 y). There is an extreme age dependence in ALT values for men: increased values were seen in 20.0% (95% CI, 19.5%-20.4%) of patients in the age group of 25 to 34 years, but only 6.7% (95% CI, 6.4%-7.0%) for the ages of 65 to 74 years. The 95th percentile reaches values greater than 80 U/L instead of 50 U/L at the age of 35, and decrease to less than 50 U/L by the age of 75. The subpopulations of prescribed routine check-up and healthy individuals showed similar qualitative results. The age dependence is much weaker for ALT in women. The proportion of women with an increased aspartate aminotransferase level increases from approximately 6% to 12% at approximately age 50. The 95th percentile for GGT increases up to the age of 60 in men, and throughout life in women. Conclusions Current guidelines and reference values for ALT imply that subsequent diagnostics are needed for a large proportion of young men. Our data strongly suggest that age adaptation should be considered.

Rationale and Objectives To investigate the diagnostic performance of histogram analysis combined with quantitative susceptibility mapping (QSM) for differentiating Parkinson's disease (PD) patients from healthy controls. Methods We included 35 patients with PD diagnosed by two neurologists from August 2019 to January 2020 in our hospital in this prospective study. The clinical diagnosis was based on the Movement Disorder Society Clinical Diagnostic Criteria for PD. At the same time, 23 healthy volunteers matched for age and sex were recruited as controls. The Mini Mental State Examination, the third part of the Parkinson's Disease Rating Scale, the Hoehn & Yahr stages, and disease duration (year) were used to assess the PD patients. QSM was performed using a 3T MR scanner. The regions of interest were depicted according to the head of the caudate nucleus(CN), globus pallidus(GP), putamina (PUT), thalmus(TH), substantia nigra (SN), red nucleus(RN), and dentate nucleus. Then the corresponding histogram features were extracted. The Mann–Whitney U test was used to identify significant histogram features for differentiating PD patients from healthy controls. Area under the receiver operating characteristics curve (AUC) analysis was conducted to evaluate the diagnostic performance of all significant histogram features. Multivariate logistic regression analysis was performed to identify the best combined model for all seven nuclei. Differences among the AUCs were compared pairwise. Results Histogram features in all nuclei except TH showed significant differences between the groups. Among the single features, the 10th percentile of SN (SNP10) yielded the highest AUC of 0.894, with the highest specificity of 86.86% for differentiating PD patients from healthy controls. The 75th percentile of PUT (PUTP75) yielded the highest sensitivity of 97.14%. In the multivariate logistic regression analysis, SNP10 combined with PUTP75 yielded the highest diagnostic performance with the highest AUC of 0.911, the highest specificity of 91.30% and an excellent sensitivity of 92.40%. Conclusion QSM combined with histogram analysis successfully distinguished PD patients from healthy controls, and the result was notably superior to the mean value.

Objective Test the hypothesis that a higher level of purpose in life is associated with an older age of Alzheimer's dementia onset and later mortality. Design Prospective cohort studies of aging and Alzheimer's dementia. Setting Community-based. Participants Two thousand five hundred fifty-eight older adults initially free of dementia underwent assessments of purpose in life and detailed annual clinical evaluations to document incident Alzheimer's dementia and mortality. General accelerated failure time models examined the relation of baseline purpose in life with age at Alzheimer's dementia diagnosis and mortality. Exposures Purpose in life was assessed at baseline. Main Outcomes Alzheimer's dementia diagnosis was documented annually based on detailed clinical evaluations and mortality was documented via regular contacts and annual evaluations. Results During a mean of 6.89 years of follow-up, 520 individuals were diagnosed with incident Alzheimer's dementia at a mean age of 88 (SD = 6.7; range: 64.1–106.5). They had a mean baseline level of purpose in life of 3.7 (SD = 0.47; range: 1–5). A higher level of purpose in life was associated with a considerably later age of dementia onset (estimate = 0.044; 95% CI: 0.023, 0.065); specifically, individuals with high purpose (90th percentile) developed Alzheimer's dementia at a mean age of about 95 compared to a mean age of about 89 for individuals with low purpose (10th percentile). Further, the estimated mean age of death was about 89 for individuals with high purpose compared to 85 for those with low purpose. Results persisted after controlling for sex and education. Conclusion and relevance Purpose in life delays dementia onset and mortality by several years. Interventions to increase purpose in life among older persons may increase healthspan and offer considerable public health benefit.

Objective To investigate the association of the maternal serum albumin (MAlb) level with fetal growth and fetal growth restriction (FGR) risk in term-born singletons. Design Prospective cohort study. Setting Four hospital maternity units of the Tongji Maternal and Child Health Cohort study initiated from September 2013 to April 2016 at Wuhan City, in central China. Patient(s) A total of 3,065 mother–offspring pairs. Intervention(s) None. Main Outcome Measure(s) Fetal growth was evaluated by birth weight (BW) and birth length. Fetal growth restriction was defined as BW below the 10th percentile. Result(s) All MAlb levels were within the upper limit of normal. After adjustment for liver function parameters, inflammatory indicators, and others, a reverse U-shaped relationship between MAlb and fetal growth was observed. Specifically, BW increased significantly with an increasing MAlb level when the MAlb level was 36.1 g/L (per g/L: β = −15.1; 95% CI, −21.2, −8.9). There was a similar association between MAlb and birth length. Furthermore, the adjusted odd ratios of FGR across increasing tertiles of the MAlb levels were 1.0 (reference), 1.1 (0.7, 1.8), and 1.7 (1.0, 2.6). Conclusion(s) There was a reverse U-shaped association between MAlb and fetal growth. A higher MAlb level was associated with an increased risk of FGR. Clinical Trial Registration Number NCT03099837.

Increasing heatwaves and extreme temperatures have recently been observed across Central Asia (CA). Accurately assessing and projecting the changing climate extremes at the local (station) scale required for climate risk management are therefore highly important. However, global and regional climate models often fail to represent the statistical distributions of observed daily extreme variables and hence extremes in complex terrain. In this work, we developed a statistical downscaling (SD) model to project summer daily maximum temperature (Tmax) and heatwave indices for 65 meteorological stations in CA toward 2100. The SD model involves first-order autoregression and multiple linear regression using large-scale Tmax and circulation indices (CIs) as predictors, and the model is cross-validated against historical observations. The local Tmax and heatwave indices are then projected for 2015–2100 driven by the output of a global climate model (CNRM-CM6-1) under four Shared Socioeconomic Pathways (SSP126, SSP245, SSP370, and SSP585). The application of the SD model significantly improves forecasting of the probability distribution (10th/90th percentiles) of Tmax at stations, particularly across mountainous regions. The model also captures interannual variability and the long-term trend in Tmax, consistent with synoptic-scale inputs. SD projections demonstrate strong warming trends of summer Tmax in CA toward 2100 with rates between 0.35–0.64 °C per decade based on the SSP245 and SSP370 scenarios. Consequently, heatwave occurrence is projected to rise by 1.0–5.0 and 2.0–7.0 d per decade under the SSP245 and SSP370 scenarios, respectively, by 2100. Duration, intensity, and amplitude of heatwaves rise at greater rates under higher-emission scenarios, particularly in southeastern CA. The proposed SD model serves as a useful tool for assessing local climate extremes, which are needed for regional risk management and policymaking for adaption to climate change.

Purpose The aim of this study is to compare age-variant 18 health risk factors by constructing longitudinal predictive curves between African-American (AA) and Caucasian American (CA) adolescent girls. Methods A total of 2,379 girls (51% AA) from ages 9 to 10 were recruited in the National Heart, Lung, and Blood Institute Growth and Health Study. The various health indicators and dietary habits of these girls were assessed annually for 10 years. We model 2nd, 5th, 95th, and 98th percentile values of the health risk factors to compare trajectories between AA and CA adolescents by employing novel kernel smoothing regression and global tests of equality for regression curves. Health risk factors such as dietary fiber, intake of sodium, sugar, and total calories, systolic blood pressure, weight, body fat percentage, and high-density lipoprotein levels were compared. Results Trajectories of sugar, sodium, and total calories intake and systolic blood pressure, weight, body fat percentage, and high-density lipoprotein among AA girls were significantly higher than those of CA girls throughout their adolescence. Conclusions AA girls exhibit several health risk factors that are significantly higher than those of CA adolescent girls at the 95th and 98th percentile. Interventions may be warranted for the purposes of ensuring access to health risk information as well as a greater ease of access to healthier food choices within the educational food system.

Objectives In elite figure skaters, to determine if there was a difference in volumetric bone mineral density and bone strength between 1) figure skaters and population-based normative data, 2) single or pair skaters and ice dancers, and 3) the landing and takeoff legs. Design Cross-sectional. Methods Figure skaters had their non-dominant distal radius and bilateral tibia scanned using high-resolution peripheral quantitative computed tomography. Volumetric bone mineral density was determined at the total, cortical and trabecular compartments, and finite element analysis estimated bone strength. Normative data was used to compare the total bone mineral density of figure skaters to a population-based cohort. Independent t-tests compared differences between skating discipline, and paired t-tests compared skeletal parameters for the landing and takeoff leg. Results Twenty elite skaters (mean age 22 ± 6.2; female = 11, male = 9) completed scans. Compared with the general population, the mean percentile rank for skaters' total volumetric bone mineral density was below normal at the radius (27th percentile) and normal at the tibia (54th percentile). Single or pair skaters had more robust bone in the landing compared with their takeoff leg. Specifically, the landing leg had higher total bone mineral density (2.8%) and trabecular bone mineral density (6.5%), and superior bone strength (8.5%) than the takeoff leg (p Conclusions Volumetric bone mineral density and strength differences in figure skaters were discipline dependent. Side-to-side differences were observed in single and pair skaters where the landing leg is denser, larger and stronger than the takeoff leg.

Objective To explore the efficacy of the quantitative parameter histogram analysis of intravoxel incoherent motion (IVIM) for different molecular prognostic factors of breast cancer. Materials and methods A total of 72 patients with breast cancer who were confirmed by surgical pathology and underwent preoperative magnetic resonance imaging (MRI) were analyzed retrospectively. A region of interest (ROI) was drawn in each slice of the IVIM images. Whole-tumor histogram parameters were obtained with Firevoxel's software by accumulating all ROIs. Next, Kolmogorov-Smirnov test, Student's t-test, Mann-Whitney U test, receiver operating characteristic curve analysis and spearman rank correlation analysis were used to assess the relationship between histogram parameters and molecular prognostic factors of breast cancer. Results Among estrogen receptor (ER)-negative ROCs, the apparent diffusion coefficient (ADC) 10th percentile had the highest ROC of 0.792, with a cut-off value of 0.788 × 10−3 mm2/s, and sensitivity and specificity of 0.714 and 0.867, respectively. The negative correlation between lymph node metastasis status and ADC standard deviation was significant (ρ = −0.44, the correlation coefficients was represented by ρ). Positive correlations were observed between hormonal expression of ER and progesterone receptor (PR) with heterogeneity metrics of ADC or perfusion fraction (f), such as ADC inhomogeneity (ρ = 0.37, ρ = 0.29) and f skewness (ρ = 0.32, ρ = 0.28). Negative correlations were observed with numerical metrics, such as the ADC median (ρ = −0.31, ρ = −0.34) and f 45th percentile (ρ = −0.35, ρ = −0.28). The positive correlations between human epidermal receptor factor-2 (HER2) and pseudo-diffusivity (Dp) numerical metrics, Ki-67 expression, and heterogeneity metrics of Dp were high. Conclusions The ADC 10th percentile had the largest area under the curve in the ER-negative ROC analysis, and the ADC standard deviation was the most valuable in the correlation analysis of lymph node metastasis. Whole-lesion quantitative histogram parameters of IVIM could, therefore, provide a scientific basis for radiomics to further guide clinical practice in the prognosis of breast cancer.

Background and purpose Increasing evidence suggests that genomic and molecular markers need to be integrated in grading of meningioma. Telomerase reverse transcriptase promoter (TERTp) mutation is receiving attention due to its clinical relevance in the treatment of meningiomas. The predictive ability of conventional and diffusion MRI parameters for determining the TERTp mutation status in grade II meningiomas has yet been identified. Material and methods In this study, 63 patients with surgically confirmed grade II meningiomas (56 TERTp wildtype, 7 TERTp mutant) were included. Conventional imaging features were qualitatively assessed. The maximum diameter, volume of the tumors and histogram parameters from the apparent diffusion coefficient (ADC) were assessed. Independent clinical and imaging risk factors for TERTp mutation were investigated using multivariable logistic regression. The discriminative value of the prediction models with and without imaging features was evaluated. Results In the univariable regression, older age (odds ratio [OR] = 1.13, P = 0.005), larger maximum diameter (OR = 1.09, P = 0.023), larger volume (OR = 1.04, P = 0.014), lower mean ADC (OR = 0.02, P = 0.025), and lower ADC 10th percentile (OR = 0.01, P = 0.014) were predictors of TERTp mutation. In multivariable regression, age (OR = 1.13, P = 0.009) and ADC 10th percentile (OR = 0.01, P = 0.038) were independent predictors of variables for predicting the TERTp mutation status. The performance of the prediction model increased upon inclusion of imaging parameters (area under the curves of 0.86 and 0.91, respectively, without and with imaging parameters). Conclusion Older age and lower ADC 10th percentile may be useful parameters to predict TERTp mutation in grade II meningiomas.

A size-by-association kinetic characterization for galena-chalcopyrite flotation is presented. The size-by-size maximum recovery R∞ and flotation rate distribution f(k) are first estimated by least-squares estimation (LSE) in four size classes. Gamma f(k)s are assumed in all cases. LSE is also used in the association categories subject to constraints to match/approach the size-by-size R∞-f(k)s pairs from the association classes. The methodology allows the size-by-size f(k)s to be explained from the size-by-association f(k)s. These size-by-association f(k)s do not converge to deterministic rate constants, which agree with the effect of other particle properties on the flotation response. The f(k)s in the −20 μm class are approximately 80–85% justified by liberated particles. These particles explain the fast-floating material in all size classes. Binary and complex middlings typically concentrate to slower flotation rates. From the f(k) results, slow-rate fractions are estimated from a low f(k) percentile. These fractions are not consistently attributed to complex middlings.

Purpose Race-adjusted interpretation of data from Cirrus high-definition OCT (HD-OCT) devices is not standard practice. The aim of this study is to evaluate differences in peripapillary retinal nerve fiber layer (RNFL) thickness between healthy Black Americans and the Cirrus HD-OCT normative database. Design This is a cross-sectional observational study using control patients recruited from the greater Philadelphia, Pennsylvania, area. Participants A total of 466 eyes were included in this study. Subjects were retrospectively identified from the control cohort of the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Methods Using an age-stratified or linear regression method, we reclassified white-green-yellow-red color probability codes for RNFL thicknesses by quadrant. Main Outcome Measures The distribution of reclassified color codes was compared with the expected 5%-90%-4%-1% percentiles and to the original color codes by the Cirrus machine. Results Average RNFL thickness in the POAAGG control cohort was thinner than in the Cirrus normative database in all except the nasal quadrant. The original color codes of the POAAGG cohort did not fall into the expected distributions, with more RNFL measurements assigned as white and red codes than expected (9.5% and 1.7%) and fewer measurements assigned as green and yellow codes than expected (85.3% and 3.5%) (P Conclusions Results further establish the presence of structural differences in the RNFL of Black American patients. Color code reclassification suggests that the existing Cirrus database may not be accurately evaluating glaucomatous nerves in patients of African descent. This study addresses an unmet need to assess Cirrus HD-OCT color probability codes in a Black American population.

Background: This article assessed the relationship between waist circumference (WC) and cardiorespiratory fitness (CRF) of children and adolescents aged 7–18 years. Methods: Using a stratified cluster random sampling method, 92,574 children and adolescents (47,364 males and 45,210 females) were extracted. CRF was measured by performance in the 20 m shuttle run test (20mSRT) and the subsequent estimation of maximal oxygen consumption (V˙O2max) using the Léger equations. Participants were divided into five groups of WC percentiles and three groups of CRF percentiles by the Lambda Mu Sigma (LMS). The correlation between WC and CRF was examined by one-way ANOVA and curvilinear regression analysis. Results: WC increased with age, while V˙O2max showed an age-related decline. Controlling for gender, urban, and rural factors, for children and adolescents aged 10–12, 13–15, and 16–18 years, the V˙O2max Z-score of the normal WC group was significantly higher than the very low WC group (P

Brain age is a neuroimaging-based biomarker of aging. This study examined whether the difference between brain age and chronological age (brain-PAD) is associated with cognitive function at baseline and longitudinally. Participants were relatively healthy, predominantly white community-dwelling older adults (n = 531, aged ≥70 years), with high educational attainment (61% ≥12 years) and socioeconomic status (59% ≥75th percentile). Brain age was estimated from T1-weighted magnetic resonance images using an algorithm by Cole et al., 2018. After controlling for age, gender, education, depression and body mass index, brain-PAD was negatively associated with psychomotor speed (Symbol Digit Modalities Test) at baseline (Bonferroni p < 0.006), but was not associated with baseline verbal fluency (Controlled Oral Word Association Test), delayed recall (Hopkins Learning Test Revised), or general cognitive status (Mini-Mental State Examination). Baseline brain-PAD was not associated with 3-year change in cognition (Bonferroni p > 0.006). These findings indicate that even in relatively healthy older people, accelerated brain aging is associated with worse psychomotor speed, but future longitudinal research into changes in brain-PAD is needed.

Summary Background and aims Many critically ill patients experience increased blood glucose variability (BGV). The objective of the current pilot study was to assess the relationship between muscle composition (defined as average Hounsfield units (HU)) among ICU patients with an abdominal CT scan within seven days of intubation, and BGV (defined as coefficient of variation (CV)) calculated from blood glucose levels measured each morning while intubated. Methods The first serum blood glucose measurement obtained each day during intubation was recorded, blood glucose CV ((mean/SD)∗100) was calculated. Cross-sectional muscle area (CSA; cm2) at the third lumbar region was identified using the −29 to +150 HU range; muscle composition was calculated as the average HU. BGV predictors were determined using linear regression. Results Eighty-two patients were included (53% female), with a median age of 64 (25th, 75 percentile (IQR): 51, 70) years. The median CV was 29% (IQR: 20, 37); 40% of subjects required insulin. The median CSA was 100.4 cm2 (IQR: 84.0, 120.8) and muscle composition was 20.4 HU (IQR: 12.2, 29.4). Patients received only 36% of estimated calorie requirements. Insulin administration, history of diabetes, and muscle composition were significant BGV predictors. Conclusion Among these adult intubated ICU patients, higher muscle composition was associated with lower BGV. Future research is needed to corroborate these findings, determine other factors associated with poor muscle quality, and identify methods to describe muscle composition for all ICU patients.

Background Cytokine measurements to support clinical laboratory and research investigations have become increasingly common in pediatrics. However, there is a paucity of accurate pediatric reference intervals (RIs) essential to the interpretation of cytokine results. To address this gap, here, we establish age- and sex-specific pediatric reference values for clinically relevant inflammatory markers including CD163, and the cytokines IL-1β, IL-6, IL-10, IL-18, TNF-α, IFN-γ, and CXCL-9. Methods Healthy children and adolescents (n = 311, 1–19 years) were recruited as part of the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) study. Multi-analyte measurements in plasma and analytical performance verification were conducted on the ProteinSimple® Ella™ automated immunoassay platform (Bio-Techne, MN, USA). Age- and sex-specific RIs were calculated based on Clinical and Laboratory Standards Institute guidelines. Additionally, 75th and 95th percentile cut-offs were determined. Results Three types of reference value distributions were observed: (a) consistent levels throughout age and sex: IL-6, and IFN-γ, (b) gradual decline in concentration with age: CD163, TNF-α, CXCL-9, and IL-10, (c) significantly higher concentrations during ages 4–14 years than earlier and later ages: IL-1β and IL-18. Reference values for CXCL-9, IL-10, and TNF-α under 8 years of age differed significantly from older children. CD163, IL-18 and IL-1β required three age partitions. CD163 demonstrated significant sex differences in ages 8–13 years. Conclusion The circulating profile of cytokines in children is complex and can vary by age and sex. This necessitates careful interpretation of test results based on age and/or sex specific RIs facilitating more accurate clinical decision making.

Objectives Studies suggest preeclampsia as a risk factor for long term cardiovascular diseases (CVD), while evidence is limited regarding the risk of high blood pressures (BP) in early pregnancy. Study design A register-based follow-up of 2434 mothers in the Helsingborg Birth Cohort. Associations of high BP in early pregnancy (>95th percentile systolic [SBP], diastolic [BDP], or mean arterial BP [MAP]) during the first antenatal visit and/or preeclampsia with an incident CVD event (ischemic heart disease or stroke) were assessed. To model risks and adjust for co-variables, Cox proportional hazard regression was used. Results Of the included women, 120 (4.9%) had high SBP, 49 (2%) high DBP, 104 (4.3%) high MAP in early pregnancy; and 115 (4.7%) developed preeclampsia. During 52 years of follow-up, totalling 121,457 person-years, 534 (21.9%) women experienced a CVD event. Women with preeclampsia had a higher risk of developing CVD compared to women without preeclampsia (HR 1.5, 95%CI: 1.1–2.2), while risks among women with high BPs were slightly higher. In adjusted analysis, risk estimates were approximately 50% higher than that of the reference groups for all four studied exposures. Of women with later CVD, 35 (6.6%) had preeclampsia, and another 31 (5,8%) women high SBP or high MAP. Without later preeclampsia, high SBP constituted a significant risk factor (HR 1.6, 95%CI: 1.1–2.4) for CVD. Conclusions Women with SBP > 95th percentile in early pregnancy, but without later preeclampsia, have a higher risk of developing CVD that is comparable to women with history of preeclampsia.

Background Graduated compression garments (CG) are a standard form of management of post-thrombotic syndrome (PTS) in adults, but data in children are lacking. We aimed to study the attitudes toward CG and change in PTS severity score in children who were prescribed CG for PTS management. Methods Children with PTS were enrolled in this longitudinal prospective study at the time of CG prescription. PTS severity was measured at baseline and follow-up using CAPTSure© ; attitude toward CG was registered at follow-up. Results Forty-five patients were enrolled (median age 13 years, 25th -75th percentile 7-15 years; 53% male patients); 71% were prescribed socks and 29% sleeves; pressure was 15-20 mmHg in 84% of CG. Median baseline PTS CAPTSure© score was 31 points (25th -75th percentile 21-45 points). At follow-up, 49% of patients found CG helpful, 27% found CG not helpful, and 16% did not buy or wear the CG. Eight percent of enrolled patients did not return for study follow-up. Ninety-five percent of the children who found CG helpful wore them for ≥3 days/week. Hours of CG wear at the time of follow-up were associated with lower PTS scores at follow-up in a non-linear manner (e.g., wearing 12 vs 0 hours/day was associated with a 16-point reduction in PTS scores at follow-up, 95% CI -29 to -2 points). Conclusion Nearly half the patients who were prescribed CG found them helpful. We observed non-linear improvement in PTS severity with the use of low-pressure CG for 8-12 hours/day and ≥3 days/week, providing guidance in their prescription.

Background & aims Increased intrapancreatic fat is associated with pancreatic diseases; however, there are no established objective diagnostic criteria for fatty pancreas. On non-contrast computed tomography (CT), adipose tissue shows negative Hounsfield Unit (HU) attenuations (−150 to −30 HU). Using whole organ segmentation on non-contrast CT, we aimed to describe whole gland pancreatic attenuation and establish 5th and 10th percentile thresholds across a spectrum of age and sex. Subsequently, we aimed to evaluate the association between low pancreatic HU and risk of pancreatic ductal adenocarcinoma (PDAC). Methods The whole pancreas was segmented in 19,456 images from 469 non-contrast CT scans. A convolutional neural network was trained to assist pancreas segmentation. Mean pancreatic HU, volume, and body composition metrics were calculated. The lower 5th and 10th percentile for mean pancreatic HU were identified, examining the association with age and sex. Pre-diagnostic CT scans from patients who later developed PDAC were compared to cancer-free controls. Results Less than 5th percentile mean pancreatic HU was significantly associated with increase in BMI (OR 1.07; 1.03–1.11), visceral fat (OR 1.37; 1.15–1.64), total abdominal fat (OR 1.12; 1.03–1.22), and diabetes mellitus type 1 (OR 6.76; 1.68–27.28). Compared to controls, pre-diagnostic scans in PDAC cases had lower mean whole gland pancreatic HU (−0.2 vs 7.8, p = 0.026). Conclusion In this study, we report age and sex-specific distribution of pancreatic whole-gland CT attenuation. Compared to controls, mean whole gland pancreatic HU is significantly lower in the pre-diagnostic phase of PDAC.

Introduction: Early identification of neonates exposed to drugs of abuse during pregnancy allows a more precise clinical management. Objectives: To describe the clinical characteristics and to identify risk factors associated with the early detection of neonates exposed to drugs of abuse in a Neonatal Intermediate and Intensive Care Unit. Methods: Prospective observational study of neonates with and without clinical suspicion of prenatal exposure to drugs of abuse. Meconium was analyzed using standard chromatographic techniques. Univariate and multivariate statistical analyzes were performed. Results: 372 neonates were included. Exposure to drugs of abuse was detected in 49 (13.2%) cases: in 41 (83.7%) one drug and in 8 (16.3%) more than one. Somatometry at birth revealed: a) lower length percentile in those exposed to some drug, more than one and cannabis; b) lower weight percentile in those exposed to cannabis and of these compared to those exposed to alcohol. In neonates older than 34 pregnancy weeks (PW): a) lower length percentile in those exposed to any substance; b) lower percentile of length and weight in exposed to more than one. The most clinically relevant independent risk factors useful to detect cases of prenatal exposure to drugs of abuse were (Odds ratio (95% CI)): reason for admission other than prematurity (5.52 (2.55-1.93)), length percentile less than 33 (1.95 (1.05-3.60) and 2.14 (1.04-3.40) in older than 34 PW) and social dystocia/uncontrolled pregnancy in older than 34 PW (4.47 (1.03-19.29)). Conclusions: There are somatometric alterations and risk factors that can help in the early detection of neonates exposed to drugs of abuse. The somatometric alterations identified can be useful to extend the differential diagnosis of these alterations and to study their causes. Resumen: Introducción: La identificación temprana de los neonatos expuestos a drogas de abuso permite realizar un manejo clínico más preciso. Objetivos: Describir las características clínicas e identificar factores de riesgo asociados a la detección precoz de neonatos expuestos a drogas de abuso en una Unidad de Cuidados Intensivos e Intermedios Neonatales. Métodos: Estudio observacional prospectivo de neonatos con y sin sospecha clínica de exposición prenatal a drogas de abuso. Se analizó meconio empleando técnicas cromatográficas estandarizadas. Se realizaron análisis estadísticos univariante y multivariante. Resultados: Se incluyeron 372 neonatos. En 49 (13,2%) casos se detectó exposición a alguna droga de abuso; en 41 (83,7%) a una, y en ocho (16,3%) a más de una. La somatometría al nacimiento objetivó: a) menor percentil de longitud en expuestos a alguna droga, a más de una y a cannabis; b) menor percentil de peso en expuestos a cannabis, y de éstos en comparación con los expuestos a alcohol. En mayores de 34 semanas de gestación (SG): a) menor percentil de longitud en expuestos a alguna droga; b) menor percentil de longitud y peso en expuestos a más de una. Los factores de riesgo independientes clínicamente útiles para detectar casos de exposición prenatal a drogas de abuso fueron (odds ratio [IC 95%]): motivo de ingreso distinto a prematuridad (5,52 [2,55-1,93]), percentil de longitud menor a 33 (1,95 [1,05-3,60]) y (2,14 [1,04-3,40]) en mayores de 34 SG y distocia social/embarazo no controlado en mayores a 34SG (4,47 [1,03-19,29]). Conclusiones: Existen alteraciones somatométricas y factores de riesgo que pueden ayudar a detectar precozmente a los neonatos expuestos a drogas de abuso. Las alteraciones somatométricas identificadas pueden servir para ampliar su diagnóstico diferencial y el estudio de sus causas.

Lack of blood pressure control leads to a higher incidence of hypertension-mediated target organ damage (HMOD). One of the markers of HMOD is an increased arterial stiffness, an independent predictor of cardiovascular complications. However, abstract numbers showing the level of arterial stiffness do not give patients a clear understanding of the risk of their condition. In order to increase patient compliance, the term "vascular age" (VA) was introduced. Arteriosclerosis plays the main role in increasing VA. The greatest interest, according to the literature, in the study of this issue is in arteriosclerosis caused by transforming growth factor β1 (TGF-β1)-the effect of TGF-β1 on the culture of smooth muscle cells leads to their proliferation and growth; also, TGF-β1 increases the amount of collagen and accelerates the degradation of elastin.We included 140 people in the study: 80 patients with controlled arterial hypertension (CAH), 30 with uncontrolled arterial hypertension (UAH), and 30 patients who formed the control group. All patients underwent a determination of arterial stiffness and VA using the cardio-ankle vascular index (CAVI), a corrected (blood-pressure independent) cardio-ankle vascular index (CAVIThe TGF-β1 value in the UAH group was 22.6 (25th percentile=20.6; 75th percentile=25.6) ng/mL, and in the control group it was 17.4 (25th percentile=11.8; 75th percentile=19.3) ng/mL. In the CAH group, an intermediate value was noted-19.2 (25th percentile=17.2; 75th percentile=24.7) ng/mL. The CAVI in the UAH group was 9.2 (25th percentile=8.5; 75th percentile=9.9), in the control group-7 (25th percentile=6.5; 75th percentile=7.5). In the CAH group, the average CAVI was 7.8 (25th percentile=7.0; 75th percentile=8.5). The CAVI 0 in the UAH group was 14.8 (25th percentile=12.0; 75th percentile=15.6), in the control group - 9.7 (25th percentile=8.8; 75th percentile=9.7). In the CAH group, the average CAVI was 11.1 (25th percentile=10.1; 75th percentile=13.6). Vascular age in the UAH group was 71.5 (25th percentile=64; 75th percentile=74) years, in the CAH group 59 (25th percentile=49; 75th percentile=69) years, and in both groups (UAH, CAH), VA was significantly higher than the chronological age (p0.05). In the control group, the VA did not significantly differ from the chronological age (p0.05) and it was 54 (25th percentile=44; 75th percentile=59) years. A significant relationship was found between the TGF-β1 level and CAVI (CAH r=0.777; UAH r=0.753; p0.05), CAVI 0 (CAH r=0.625; UAH r=0.502; p0.05) and VA in patients with AH (CAH r=0.649; UAH r=0.753; p0.05).In patients in the UAH group, there was an increase in the concentration of TGF-β1, an increase in the arterial stiffness and in VA in comparison with patients in the CAH group and the control group. The relationship between TGF-β1 and the arterial stiffness and VA was revealed in patients with hypertension.

Background: To investigate postnatal growth patterns and their relationship with the neurodevelopment of preterm infants born small for gestational age (SGA). Methods: This retrospective cohort study analyzed 90 infants born SGA with a birthweight

Accurate self-assessment of knowledge and technical skills is key to self-directed education required in surgical training. We aimed to investigate the presence and magnitude of cognitive bias in self-assessment among a cohort of surgical interns.First-year general surgery residents self-assessed performance on a battery of technical skill tasks (knot tying, suturing, vascular anastomosis, Fundamentals of Laparoscopic Skills peg transfer and intracorporeal suturing) at the beginning of residency. Each self-assessment was compared to actual performance. Bias and deviation were defined as arithmetic and absolute difference between actual and estimated scores. Spearman correlation assessed covariation between actual and estimated scores. Improvement in participant performance was analyzed after an end-of-year assessment.Participants (N = 34) completed assessments from 2017 to 2019. Actual and self-assessment scores were positively correlated (0.55, P.001). Residents generally underestimated performance (bias -4.7 + 8.1). Participants who performed above cohort average tended to assess themselves more negatively (bias -7.3 vs -2.3) and had a larger discrepancy between self and actual scores than below average performers (deviation index 9.7 + 8.2 vs 3.8 + 3.1, P.05). End-of-year total scores improved in 31 (91.2%) participants by an average of 11 points (90 possible). Least accurate residents in initial self-assessments (deviation indices75th percentile) improved less than more accurate residents (median 5 vs 16 points, P.05). All residents with a deviation index75 percentile underestimated their performance.Cognitive bias in technical surgical skills is apparent in first-year surgical residents, particularly in those who are higher performers. Inaccuracy in self-assessment may influence improvement and should be addressed in surgical training.

We examined the effect of varying multimodal pain management (MMPM) combinations on oral morphine milligram equivalents (OMME) and length of stay (LOS) after total knee arthroplasty (TKA). Five groups were compared based on the combination of multimodal analgesics ranging from no MMPM to full MMPM with acetaminophen, gabapentinoids, and celecoxib. After risk adjustment, MMPM was associated with decreased odds of LOS ≥2 days and OMME ≥75th percentile. MMPM protocols are effective at reducing LOS and postoperative narcotic requirements post-TKA. Patients appear to derive similar benefit from receiving all three medications, as well as various combinations of these drugs.

Introduction Invasive Coronary Angiography (CAG) leads to significant radiation exposure to the patients. Guidelines suggest that a local landmark or Diagnostic Reference Level (DRL) for these procedures should be established for every region and country. This study attempts to create a DRL for a tertiary care hospital, acting as an interim DRL for the country/region. Methods Radiation exposure data for all coronary procedures done at a tertiary care hospital between October 2016 to September 2018 were collected. Data was segregated into diagnostic Coronary Angiography (CAG) and single-vessel Percutaneous Intervention (PCI). The parameters collected include dose surface product (PKA), skin surface entry dose (KAR), and fluoroscopy time (FT). The 75th percentile of the PKA was used to define the DRL. Results 500 Patients were included in the CAG group, in which the Median KAR was 412.05 mGy, Median PKA was 2635.7 μGysqm, and median FT was 2.25 min. The DRL for coronary angiography was calculated as 3695.1 μGysqm. Two hundred fifty patients were in the PCI group, the Median KAR was 1649 mGy, Median PKA was 8822.1 μGysqm, the median FT being 8.2 min. The DRL for single-vessel coronary intervention was calculated as 11038 μGysqm. Conclusion This study establishes a benchmark for radiation dose for diagnostic coronary angiography and single-vessel coronary intervention at a tertiary care hospital in NCR. It establishes an interim DRL that can be used for future studies in other institutions in the region and country and to compare with other countries.

To identify risk factors for increasing severity of OASI and evaluate its possible correlation with two known risk factors-birth weight (BW) and neonatal head circumference (HC).We performed a retrospective cohort study at a university affiliated hospital between 2003 and 2019. We compared five groups of patients - according to presence and degree of perineal laceration - 3a, 3b, 3c and 4 and patients without OASI. Additionally, four parameters were defined to assess their relation to the severity of OASI: (1) BW ≥ 90th and HC 90th percentiles; (2) BW 90th and HC ≥ 90th percentile; (3) BW and HC ≥ 90th percentile and (4) BW and HC 90th percentiles.During the study period, 150,221 deliveries were evaluated. Parturients were allocated according to OASI severity - 455 patients had a 3rd (3a, 3b or 3c) or 4th degree perineal tear, while 110,966 patients had no OASI. Allocation to subgroups according to offspring anthropomorphic measures showed that as fetal size parameters increased, the rate of more severe tears increased, particularly in women delivering neonates with HC ≥ 90th percentile. Multinomial regression analysis was performed for each 3rd degree OASI subgroup. This analysis demonstrated the odds for OASI gradually increase with tear severity for BW ≥ 90th percentile and the combined BW and HC ≥ 90th percentile parameters, as compared with neonates with HC and BW 90th percentile.Birth weight and head circumference above the 90th percentile are correlated with increased degree of OASI severity.

Objective Clinical risk prediction models are generally assessed on population level with a lack of measures that evaluate their stability at predicting risks of individual patients. This study evaluated the use of ranking as a measure to assess individual level stability between risk prediction models. Study Design and Setting A large patient cohort (3.66 million patients with 0.11 million cardiovascular events) extracted from the Clinical Practice Research Datalink was used in the exemplar of cardiovascular disease risk prediction. Results It was found that 15 models (including machine learning and statistical models) had similar population-level model performance (C statistics about 0.88). For patients with high absolute risks, the models were more consistent in ranking of risk predictions (interquartile range (IQR) of differences in rank percentiles -0.6 to 1.0), but inconsistent in absolute risk (IQR of differences in absolute risk -18.8 to 9.0). At low risk, the reverse was true with inconsistent ranking but more consistent absolute risk. Conclusion Consistency of ranking of individual risk predictions is a useful measure to assess risk prediction models providing complementary information to absolute risk stability. Model developing guidelines including “TRIPOD” and “PROBAST” should incorporate ranking to assess individual level stability between risk prediction models.

The paper deals with the long-term and seasonal variability of low flows using the example of a mountain river. The study covers the Laborec River in the eastern part of Slovakia, and the main aim of the research is to identify and establish long-term fluctuations of low flows on this river. The analysis aims to indicate trends of low flows and seasonal variability of outflows based on various measures and research methods as well as the links between them. Basic data on daily flow and precipitation series were collected from 1980 to 2019. Low flow periods were identified in relation to the fitting of the threshold level method to the 70th and 95th percentile on the flow duration curve as a constant, multi-annual cut-off (Q70%, Q95%). The longest lasting flows were those below q70%, which were determined in the shallow cut-offs that occurred for most of the year, i.e. from June to December and in January. The greatest culmination of flows below q95% was in August and September. The range of minimal unit outflow is the smallest in the summer-autumn period and results from long periods without precipitation and with increased evapotranspiration. The highest range of unit outflow was recorded from December to April. Knowledge of low river flows should be one of the important elements of advanced planning, which in the future may help to reduce conflicts between water users during the peak demand period.

Treating pediatric obesity is challenging. The objective was to evaluate effect of receiving a bicycle on (a) physical activity, (b) sedentary activity, (c) Body Mass Index (BMI), and (d) eating habits. A stepped-wedge randomized controlled trial of 6- to 12-year-old patients with overweight/obesity was conducted April 2012-2018. Participants were randomized to wait 0, 2, 4, or 6 months for a bicycle. Outcomes on activity, BMI and eating were collected at 3, 6, 9- and 12-months after children received a bicycle. A total of 525 participants with 387 (74%) completed 3-month follow-up questionnaire, and 346 (66%) completed 12-month follow-up visit. Participants were mostly Latino/a (71%) and low income (58%), and 31% had never ridden a bicycle. Median baseline BMI was 98th percentile. At 3 months, 62% reported bicycle use last week, on average 3.6 days. Time spent on sedentary activities decreased by 48 min/day (p = 0.04), and time spent playing sports increased by 1.7 h/week (p0.01). No reduction in BMI was seen. Consumption of sugary drinks decreased (by 0.59 servings/week, p0.01), and consumption of vegetables increased (0.71 servings/week, p = 0.04). At 12 months, sedentary time, sugary drink and vegetable consumption remained significantly more favorable than at enrollment (p0.01, p0.01, p = 0.04 respectively), but not significantly different (p = 0.47 for sedentary, p = 0.73 for sugary drink) and significantly less favorable (p0.01 for vegetables) than at the time of intervention. Participants reported riding bicycle, improved activity and dietary habits, though reversion towards baseline behavior was seen by one year and no change in BMI from enrollment.

In this study, we examined the relationships of appendicular skeletal muscle mass (ASM) and grip strength (GS) with carotid intima-media thickness (CIMT) and plaque score (PS) in patients with type 2 diabetes.A total of 1185 patients were recruited. High CIMT and high PS were defined as ≥ 75 percentile of maximal CIMT of each sex and PS ≥ 3. Patients in the lowest ASM/body mass index (BMI) or GS/BMI tertile were older and had lower HDL cholesterol, and eGFR, but higher BMI, waist circumference (WC), HOMA-IR, and C-reactive protein than those in the highest tertile. Meanwhile, individuals in the lowest ASM or GS tertile group had lower BMI and WC than those in the highest one. CIMT and PS and the prevalence of high CIMT, carotid plaques, and high PS gradually increased with decreasing tertiles of ASM, ASM/BMI, GS, and GS/BMI (p 0.001). After adjusting for age and sex, odds ratios (ORs) and 95% confidence intervals (CIs) for high CIMT and high PS were 0.98 (0.68-1.42), 1.64 (1.14-2.36), 2.000 (1.33-3.01), and 1.77 (1.22-2.58) and 1.63 (1.16-2.30), 1.78 (1.28-2.54), 1.91 (1.33-2.75), and 1.61 (1.13-2.28) in the lowest tertile of ASM, ASM/BMI, GS, and GS/BMI, respectively. After further adjusting for potential confounders, ORs and 95% CI for high CIMT and high PS remained significant in the lowest tertile group.Low ASM and low GS may be independent risk factors for high CIMT and high PS in patients with type 2 diabetes.

Made available in DSpace on 2022-04-29T08:31:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Objectives: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Methods: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March–July, 2020. The model was validated in the 1054 patients admitted during August–September, as well as in an external cohort of 474 Spanish patients. Results: Median (25–75th percentile) age of the model-derivation cohort was 60 (48–72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829–0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833–0.885]) and Spanish (0.894 [95% CI 0.870–0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). Conclusions: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19. Department of Internal Medicine Medical School Universidade Federal de Minas Gerais Telehealth Center University Hospital Universidade Federal de Minas Gerais Institute for Health Technology Assessment IATS/ CNPq)., Rua Ramiro Barcelos, 2359. Prédio 21 | Sala 507 Department of Statistics Universidade Federal de Minas Gerais Center for Research and Graduate Studies in Business Administration Universidade Federal de Minas Gerais Universidade Federal de São João del-Rei Infectious Diseases Department Vall d'Hebron University Hospita Universitat Autònoma de Barcelona Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor Grupo Hospitalar Conceição Pontifícia Universidade Católica do Rio Grande do Sul RGS) Hospital São Lucas PUCRS Rede Mater Dei de Saúde Hospital Márcio Cunha Universidade do Sul de Santa Catarina UNISUL Dissertare Scientific Advice SOS Cardio Hospital Internal Medicine Department University Hospital Universidade Federal de Minas Gerais Faculdade de Medicina de Botucatu Universidade Estadual Paulista Júlio de Mesquita Filho Hospital das Clínicas da Faculdade de Medicina de Botucatu Universidade Federal do Rio Grande do Sul Hospital Bruno Born Research Center of Vale do Taquari. Hospital Mãe de Deus Hospital Universitário de Canoas Mucuri Medical School FAMMUC Universidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM Hospital Santa Rosalia Hospital Metropolitano Doutor Célio de Castro Hospital Moinhos de Vento Hospital Unimed BH Hospital Risoleta Tolentino Neves Post-graduation Center Medical School Universidade Federal de Minas Gerais Hospital Metropolitano Odilon Behrens Hospital Eduardo de Menezes Universidade FUMEC Hospital Julia Kubitschek Hospital Universitário de Santa Maria Departamento de Medicina Interna Universidade Federal de Santa Maria Hospital São João de Deus Hospital Regional Antônio Dias Faculdade Ciências Médicas de Minas Gerais Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Faculdade de Ciências Humanas de Curvelo Hospital João XXIII Av. Professor Alfredo Balena Hospital Santo Antônio Hospital Universitário Ciências Médicas Vall d'Hebron University Hospital PROSICS Barcelona Instituto René Rachou-FIOCRUZ Minas. Universidade Federal da Fronteira Sul Hospital Regional do Oeste Pontifícia Universidade Católica de Minas Gerais Hospital Tacchini Centro Universitário de Patos de Minas. RPatos de Minas Hospital Semper Hospital Santa Cruz Universidade de Santa Cruz Fundação Hospitalar do Estado de Minas Gerais – FHEMIG. Universidade Federal de Ouro Preto Hospital das Clínicas da Universidade Federal de Pernambuco Universidade Federal de Pernambuco Centro de Ciências Médicas Centro Universitário de Belo Horizonte UniBH) Erasmus MC University Medical Center Rotterdam Department of Cardiology Faculdade de Medicina de Botucatu Universidade Estadual Paulista Júlio de Mesquita Filho Hospital das Clínicas da Faculdade de Medicina de Botucatu

Although tropical cyclone (TC) track forecast errors (TFEs) of operational warning centres have substantially decreased in recent decades, there are still many cases with large TFEs. The International Grand Global Ensemble (TIGGE) data are used to study the possible reasons for the large TFE cases and to compare the performance of different numerical weather prediction (NWP) models. Forty-four TCs in the western North Pacific during the period 2007–2014 with TFEs (+24 to +120 h) larger than the 75th percentile of the annual error distribution (with a total of 93 cases) are identified. Four categories of situations are found to be associated with large TFEs. These include the interaction of the outer structure of the TC with tropical weather systems, the intensity of the TC, the extension of the subtropical high (SH) and the interaction with the westerly trough. The crucial factor of each category attributed to the large TFE is discussed. Among the TIGGE model predictions, the models of the European Centre for Medium-Range Weather Forecasts and the UK Met Office generally have a smaller TFE. The performance of different models in different situations is discussed.

Elevated plasma methylmalonic acid (MMA) and/or total homocysteine (tHcy), as well as low serum vitamin B12 and/or holotranscobalamin (holoTC) are indicative of vitamin B12 deficiency. Combined indicators (cB12), which pool some or all 4 markers into an index, may be a more reliable diagnostic tool to overcome inconclusive diagnoses with individual markers.We aimed to describe different cB12 score combinations and estimate the prevalence of low or transitional vitamin B12 status compared with individual markers.Using cross-sectional data for B12, MMA, and tHcy in persons ≥20 y participating in NHANES 1999-2004 (n = 12,335), we examined raw and covariate-adjusted regression models to assess determinants of 3cB12 (all 3 markers) and combinations of 2cB12 (2 markers).3cB12 was significantly associated with B12 (Spearman r = 0.75), MMA (r = -0.70), and tHcy (r = -0.59). The 3cB12 reference interval (2.5th to 97.5th percentile) was -0.538 to 1.60. In covariate-adjusted models, we found no association of 3cB12 with age; adult females and users of B12 supplements had higher, while adults with advanced chronic kidney disease had lower 3cB12 levels regardless of race-Hispanic origin group (self-reported). Only 2.7% of adults had low or transitional vitamin B12 status using the proposed cB12 cutoff of ≤-0.5, while the prevalence of low (or low-normal) status depended on the selected individual marker and its cutoff: 2.2% and 13% for B12 148 and 148-222 pmol/L, respectively; 6.0% for MMA exceeding an age-specific cutoff (250-320 nmol/L); and 8.4% for tHcy 13 µmol/L. The reference intervals for B12, MMA, and tHcy overlapped from the low (-2.5) to the transitional (-2.5 to -0.5) and to the adequate (-0.5) cB12 categories.Vitamin B12 deficiency may be overestimated among US adults when individual, conventional markers are used. When only 2 markers are available, the combination of B12 and MMA provides results comparable to 3cB12.

Stress testing is often used before abdominal aortic aneurysm (AAA) repair. Whether stress testing leads to a reduction in cardiac events after AAA repair has remained unclear. Our objective was to study the national stress test usage rates and compare the perioperative outcomes between centers with high and low usage of stress testing.We used the Vascular Quality Initiative to study patients who had undergone elective endovascular AAA repair (EVAR) or open AAA repair (OAR). We measured the usage rates of stress testing across centers and compared the Vascular Study Group of New England cardiac risk index (VSG-CRI) among patients who had and had not undergone preoperative stress testing. We determined the rate of major adverse cardiac events (MACE), a composite of perioperative myocardial infarction, stroke, heart failure exacerbation, and death across the centers. We compared the MACE and 1-year mortality between the centers in the highest quintile of stress test usage and the lowest quintile.We studied 43,396 EVAR patients and 8935 OAR patients across 324 centers. The median proportion of stress test usage across centers before EVAR was 35.9% and varied from 10.2% (5th percentile) to 73.7% (95th percentile), with similar variability for OAR (median, 57.9%; 5th percentile, 13.0%; 95th percentile, 86.0%). The mean VSG-CRI for the EVAR group with preoperative stress testing was 5.6 ± 2.1 compared with 5.4 ± 2.1 (P .001) for the EVAR group without preoperative stress testing. The findings were similar for OAR, with a VSG-CRI of 5.1 ± 2.0 vs 4.8 ± 2.1 (P .001) for those with and without preoperative stress testing, respectively. The rate of MACE was 1.8% after EVAR and 11.6% after OAR. The 1-year mortality was 4.6% for EVAR and 6.6% for OAR. The centers in the highest quintile of stress testing had a higher adjusted likelihood of MACE after both EVAR (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.37-2.30) and OAR (OR, 1.99; 95% CI, 1.53-2.59) but similar 1-year mortality (EVAR: OR, 1.18; 95% CI, 1.02-1.37; OAR: OR, 0.87; 95% CI, 0.65-1.17) compared with the centers in the lowest quintile. The VSG-CRI was not different between the high stress test centers (EVAR, 5.5 ± 2.1; OAR: 5.0 ± 2.0), and low stress test centers (EVAR, 5.5 ± 2.1; P = .403; OAR, 4.9 ± 2.0; P = .563).Stress test usage before AAA repair varied widely across Vascular Quality Initiative centers despite similar patient risk profiles. No reduction was observed in MACE or 1-year mortality among centers with high stress test usage. The value of routine stress testing before AAA repair should be reconsidered, and stress testing should be used more selectively, given these findings and the associated costs of widespread testing.

We sought to investigate the association between diabetes mellitus and incidence of adverse outcomes in patients who underwent meningioma surgery.The 2012-2014 National Inpatient Sample database was used. Prolonged length of stay was indicated by values greater than the 90th percentile of the sample. The Fisher exact test and analysis of variance were used to compare demographics, hospital characteristics, comorbidity, and complications among race cohorts. Logistic regression was used to analyze the independent effect of diabetes on adverse outcomes.After selecting for patients with primary diagnosis of meningioma who underwent a resection procedure, 7745 individuals were identified and divided into diabetic (n = 1518) and nondiabetic (n = 6227) cohorts. Demographics, hospital characteristics, and comorbidities were significantly different among the 2 cohorts. Average length of stay was longer in diabetic patients (8.15 vs. 6.04 days, P0.001), and total charges were higher in diabetic patients ($139,462.66 vs. $123,250.71, P0.001). Multivariate regression indicated diabetic patients have higher odds of experiencing a complication (odds ratio [OR] 1.442, 95% confidence interval [CI] 1.255-1.656, P0.001) and in-hospital mortality (OR 1.672, 95% CI 1.034-2.705, P = 0.036) after meningioma surgery. Analysis of individual postoperative complications revealed that diabetic patients experienced increased odds of pulmonary (OR 1.501, 95% CI 1.209-1.864, P0.001), neurologic (OR 1.690, 95% CI 1.383-2.065, P0.001), and urinary/renal complications (OR 2.618, 95% CI 1.933-3.545, P0.001). In addition, diabetic patients were more likely to have a prolonged length of stay (OR 1.694, 95% CI 1.389-2.065, P0.001).Diabetes is an important factor associated with complications after meningioma surgery. Preventative measures must be taken to optimize postoperative outcomes in these patients.

Aim of the study The ideal group size for effective teaching of cardiopulmonary resuscitation is currently under debate. The upper limit is reached when instructors are unable to correct participants’ errors during skills practice. This simulation study aimed to define this limit during cardiopulmonary resuscitation teaching. Methods Medical students acting as simulated Basic Life Support course participants were instructed to make three different pre-defined Basic Life Support quality errors (e.g., chest compression too fast) in 7 min. Basic Life Support instructors were randomized to groups of 3–10 participants. Instructors were asked to observe the Basic Life Support skills and to correct performance errors. Primary outcome was the maximum group size at which the percentage of correctly identified participants’ errors drops below 80%. Results Sixty-four instructors participated, eight for each group size. Their average age was 41 ± 9 years and 33% were female, with a median [25th percentile; 75th percentile] teaching experience of 6 [2;11] years. Instructors had taught 3 [1;5] cardiopulmonary resuscitation courses in the year before the study. A logistic binominal regression model showed that the predicted mean percentage of correctly identified participants’ errors dropped below 80% for group sizes larger than six. Conclusion This randomized controlled simulation trial reveals decreased ability of instructors to detect Basic Life Support performance errors with increased group size. The maximum group size enabling Basic Life Support instructors to correct more than 80% of errors is six. We therefore recommend a maximum instructor-to-participant ratio of 1:6 for cardiopulmonary resuscitation courses.

Background Evaluation of the external genitalia is an important part of prenatal ultrasound. However, there is no standardized methodology that includes biometric measurements and normative data to be able to carry out this evaluation. Objective To develop a standardized methodology for fetal genital biometry and obtain reference values for use in mid-trimester ultrasound. Study design A prospective cross-sectional study was used. 273 male and 253 female fetuses of normal, singleton pregnancies at 18 to 22 weeks were included. Measurements of fetal penis length, penile width and transverse scrotal diameter in male fetuses and bilabial diameter in female fetuses were performed by transabdominal ultrasound. Reference values were calculated for each gestational week. Results Realization of the open-legs axial plane is described as a working methodology. Normative data for penile length, penile width, transverse scrotal diameter and bilabial diameter are defined, including mean, minimum and maximum values, range, and 5th, 10th, 90th and 95th percentiles. Conclusions We have provided a standardized methodology using the open-legs axial plane, which would integrate the main measurements. In addition with the normative data constructed from their use, we hope to be able to improve the external genitalia assessment and diagnosis of genital anomalies in mid-trimester ultrasound.

When analyzing the causes of an accident, it is critical to determine whether the driver could have prevented the accident. In previous studies on the reaction times of drivers, the definition and values of reaction times vary, so applying reaction time is difficult. In such analysis, the driver’s reaction time from perception is required to determine whether the driver could have prevented the accident, but past studies are difficult to utilize in accident analysis as reaction time measurements were taken after the occurrence of hazardous situations. In this study, 93 subjects from age groups ranging from 20 s to 40 s participated in an experiment inside a full-scale driving simulator, to determine reaction time values that can be practically applied to accident analysis. A total of 4 hazardous accident situations were reproduced, including driving over the centerline, pedestrian jaywalking, a vehicle cutting in, and intersection traffic signal violation. The Time-To-Collision (TTC) was 2.5 s and the driving speed was set to the common city road speed limits of 60 and 80 km/h. An eye tracker was used to determine the driver’s Saccade Latency (SL) during hazardous situations. Brake Reaction Time from Perception (BRTP), Steer Reaction Time from Perception (SRTP), and Driver Reaction Time from Perception (DRTP) were derived, and the measurements were statistically analyzed to investigate differences by age group, gender, speed, and type of hazardous situation. Most participants were found to avoid collisions by braking first rather than steering for the presented hazardous situations, except for the cutting in situation. Also, to determine a reaction time that would cover most drivers, the 85th percentile of DRTP was calculated. The 85th percentile of DRTP was in the range of 0.550 – 0.800 s. Specifically for each hazardous situation, it was 0.650 s for driving over the centerline, 0.800 s for the pedestrian jaywalking, 0.660 s for cutting in, and 0.550 s for the intersection traffic signal violation. For all 4 hazardous situations combined, the 85th percentile of DRTP was 0.646 s. The findings can be utilized to determine the driver’s likelihood of avoiding accidents when faced with similar hazardous situations.

Patient-reported outcome measures such as the Pediatric Eye Questionnaire (PedEyeQ) are increasingly recognized as important in healthcare assessment. Defining normal PedEyeQ thresholds would allow classification of individual children as having reduced versus normal domain scores. We prospectively enrolled visually normal children (aged 0-17 years; n = 310) to calculate normal PedEyeQ domain thresholds. In addition, 48 children with bilateral visual impairment (VI; best-eye acuity worse than 20/70 or 20/70 or better with limited visual fields) were enrolled for validation. The Child PedEyeQ (four domains) was completed by 5- to 17-year-olds. Parents completed Proxy (five domains) and Parent PedEyeQ (four domains). Each domain was Rasch scored (converted to 0-100); normal thresholds were defined as the 5th percentile of scores in visually normal controls. For Child 5-11 PedEyeQ, 39%-78% of VI children had reduced domain scores, and 88%-100% for 12- to 17-year-olds. For Proxy PedEyeQ, proportions ranged from 55% to 100% and for Parent PedEyeQ ≥83% had reduced scores. High prevalence of reduced PedEyeQ domain scores in the VI cohort, validates the use of normal thresholds. Nevertheless, variability in child self-reporting creates challenges for identifying individual 5- to 11-year-olds with reduced scores.

Objective To determine whether first-trimester visceral adipose tissue (VAT) depth is associated with small-for-gestational-age (SGA; 90th percentile) birthweight, including when taking into consideration ethnicity-specific birthweight curves. Methods We conducted a prospective cohort study involving 452 women with a singleton livebirth. Maternal VAT depth was measured by ultrasound at 11 to 14 weeks gestation. Newborn weight was plotted on population-based and ethnicity-specific birthweight percentile curves. Modelling was performed using linear and logistic regression, adjusting for parity, smoking status, and weight gain. Results Mean maternal age was 32.9 ± 4.7 years, and mean VAT depth was 4.1 ± 1.7 cm. Using a population-based curve, each 1-cm increase in VAT depth was associated with a 1.5 (95% CI 0.03–3.0) higher birthweight percentile. Taking into account ethnicity-specific curves, a 1-cm higher VAT depth was associated with a 1.7 (95% CI 0.02–3.3) greater birthweight percentile. Using a population-based curve, comparing VAT depth Q4 with VAT depth Q1–3, the adjusted odds ratio (aOR) for LGA was 1.9 (95% CI 0.8–4.1); with ethnicity-specific curves, the aOR for LGA was 1.5 (95% CI 0.7–3.2). The aOR for SGA was 0.8 (95% CI 0.4 to 1.7) comparing Q1 with Q2–4 VAT depth. Conclusion Higher first-trimester maternal VAT depth was associated with a somewhat greater newborn weight percentile, which varies by which birthweight curve is used. There were marginally higher odds of giving birth to an LGA infant for women in highest quartile for VAT depth, with no evident association with SGA.

BACKGROUND Disease-related malnutrition is associated with loss of muscle mass and impaired functional status. Handgrip strength (HGS) has been proposed as an easy-to-use tool to assess muscle strength in clinical practice. OBJECTIVES We investigated the prognostic implications of HGS in patients at nutritional risk with regard to clinical outcomes and response to nutritional support. METHODS This was a secondary analysis of the randomized controlled, multicenter, Effect of Early Nutritional Support on Frailty, Functional Outcome, and Recovery of Malnourished Medical Inpatients Trial, which compared the effects of individualized nutritional support with usual hospital food in medical inpatients at nutritional risk. Our primary endpoint was 30-d all-cause mortality. The association between sex-specific HGS and clinical outcomes was investigated using multivariable regression analyses, adjusted for randomization, age, weight, height, nutritional risk, admission diagnosis, comorbidities, interaction terms, and study center. We used interaction terms to investigate possible effect modification regarding the nutritional support intervention. RESULTS Mean ± SD HGS in the 1809 patients with available handgrip measurement was 17.0 ± 7.1 kg for females and 28.9 ± 11.3 kg for males. Each decrease of 10 kg in HGS was associated with increased risk of 30-d mortality (female: adjusted OR: 2.11; 95% CI: 1.23, 3.62, P = 0.007; male: adjusted OR: 1.44; 95% CI: 1.07, 1.93, P = 0.015) and 180-d mortality (female: adjusted OR: 1.45; 95% CI: 1.0, 2.10, P = 0.048; male: adjusted OR: 1.55; 95% CI: 1.28, 1.89, P 10th percentile; P for interaction = 0.026). CONCLUSIONS In medical inpatients at nutritional risk, HGS provided significant prognostic information about expected mortality and complication risks and helps to identify which patients benefit most from nutritional support. HGS may thus improve individualization of nutritional therapy.This trial was registered at clinicaltrials.gov as NCT02517476.

Objective To assess the extent to which the established age-related decline in cardiorespiratory fitness (CRF) is augmented in adult men with type 2 diabetes mellitus (T2DM). Participants and Methods This study used data from the Aerobics Center Longitudinal Study, conducted between September 18, 1974, and August 3, 2006, in primarily non-Hispanic white, middle-to-upper class adults. The analyses were restricted to adult men with complete data on age, CRF, and T2DM (35,307 participants). Quantile regression models were used to estimate age-related differences in CRF, estimated using a maximal treadmill test, between persons with and without T2DM. Smoking status and birth cohort served as covariates. Results Age-related declines in CRF were observed in men with and without T2DM. For men younger than 60 years, at low-mid percentiles of the CRF distribution the magnitude of the age-related decline in CRF was significantly higher (P-values=.00, .02) in men with T2DM than in those without T2DM. At upper percentiles, the decline with age between the 2 groups was virtually identical. Significant declines in CRF in men 45 years or younger were observed only at high levels of CRF for those without T2DM and at low levels of CRF for those with T2DM (P-values .00, .04). Conclusion This study reported that men younger than 60 years with T2DM at the low-mid CRF percentiles experience an accelerated age-related decline in CRF. Men younger than 60 years with T2DM exhibiting high levels of CRF experienced a decline in CRF comparable to men without T2DM. This study highlights the importance of incorporating sufficient levels of exercise or activity to maintain high CRF in men with T2DM.

Assess effects of an obesity prevention program promoting eating self-regulation and healthy preferences in Hispanic preschool children.Randomized controlled trial with pretest, posttest, 6- and 12-month assessments. Fourteen waves, each lasting 7 weeks.Families recruited from Head Start across 2 sites.Two hundred fifty-five families randomized into prevention (n = 136) or control (n = 119).Prevention received curriculum; control received no curriculum.Feeding knowledge/practices/styles (parent); body mass index percentile, eating self-regulation, trying new foods, and fruit/vegetable consumption (child).Multilevel analyses for nested data (time points within families; families within waves) and multinomial regression.Program increased mothers' repeated presentation of new foods (P0.05), measured portion sizes (P0.05), child involvement in food preparation (P0.001), feeding responsiveness (P0.001), knowledge of best feeding practices (P0.001), and feeding efficacy (P0.05); reduced feeding misconceptions (P0.01) and uninvolved feeding (P0.01). Effects on child eating behavior were minimal. At 12 months, children in the prevention group were less likely to have overweight (P0.05) or obesity (P0.05).Program effects emphasize the importance of feeding approaches in reducing childhood obesity.

Background United States Medical Licensing Examination Step 1 (STEP 1) and Step 2 (STEP 2) scores are used in the selection of surgery residents. The American Board of Surgery In-Training Examination (ABSITE) is employed to assess resident knowledge. We sought to determine whether both STEP 1 and/or STEP 2 were predictive of ABSITE performance. Methods We performed a 10-year retrospective analysis of all PGY levels comparing STEP 1 and 2 scores with raw ABSITE scores and percentile rank. Additionally, we analyzed STEP 1 and 2 scores for the likelihood of scoring above the 20th percentile on the ABSITE. Results When STEP 1 and STEP 2 scores were evaluated separately, both were independent predictors of ABSITE performance. However, when STEP 1 and STEP 2 scores were evaluated together, only STEP 1 scores were predictive of ABSITE performance. Finally, only STEP 1 scores were predictive of scoring above the 20th percentile. Conclusion STEP 1 scores are a better predictor of ABSITE performance than STEP 2.

Hypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce.Students enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005-2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (90th percentile for SBP and/or DBP, or120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS.Of 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p.001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p.01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p.001) or obese (38.9% vs. 11.3%, p.001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (-4.0 vs. 2.8 mmHg, p.001) and DBP (-3.3 vs. .8 mmHg, p.001) than normal BP students.Abnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.