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Paciorek and Wehner raise important questions around our use of the Mann‐Kendall nonparametric trend test on smoothed data for analyzing long‐term hydrometeorological trends in Zhang et al. (2021, https://doi.org/10.1029/2020gl092293). We thank them for initiating this important conversation and their gracious cooperation in exploring the issues addressed in their comment. In this reply we confirm the inflation of significant p‐values by our choice to smooth, illustrate the relatively minor impacts on the main conclusions of our paper, and add our voices to those of Paciorek and Wehner in highlighting the lack of methodology for hypothesis testing across multiple stations that have spatial structure (i.e., testing for regionally consistent trends). Plain Language Summary: Our colleagues Drs. Paciorek and Wehner have raised concerns about our paper (Zhang et al., 2021, https://doi.org/10.1029/2020gl092293), which showed widespread increases in the duration of drought events over the last five decades in the western United States. They point out that our decision to smooth the data using a moving average inflated the number of weather stations at which the trends toward longer droughts were deemed significant by a statistical test. We agree with them on this point, and we have recomputed all our results using unsmoothed data to determine the impacts. We find that for most stations and regions, trend magnitudes remained largely unchanged, with many stations nearby one another often suggesting similar trends. Finally, we agree with Paciorek and Wehner that there is a lack of statistical methods to test such coherent regional patterns, and we caution that over‐reliance on p‐values limits the power of regional data to identify important climate trends. Key Points: We agree that smoothing to 5‐year moving windows introduced serial correlation into time series of annual statistics of daily rainfall data, inflating the number of weather stations individually showing significant trends (p < 0.05) with the Mann‐Kendall testRecomputation with unsmoothed values produced substantially the same dry intervals trend magnitude and direction at most stations individually and had only minimal impacts on dry interval trends computed for National Ecological Observatory Network domains using the Regional Kendall testNo perfect statistical approach leverages the capacity of coherent regional patterns among spatially correlated weather stations, and an over‐reliance on p‐values as a binary (significant vs. insignificant) determinant of trends limits the power of regional data [ABSTRACT FROM AUTHOR]

Multiple lines of evidence suggest climate change will result in increased precipitation variability and consequently more frequent extreme events. These hydroclimatic changes will likely have significant socioecological impacts, especially across water‐limited regions. Here we present an analysis of daily meteorological observations from 1976 to 2019 at 337 long‐term weather stations distributed across the western United States (US). In addition to widespread warming (0.2 °C ± 0.01°C/decade, daily maximum temperature), we observed trends of reduced annual precipitation (−2.3 ± 1.5 mm/decade) across most of the region, with increasing interannual variability of precipitation. Critically, daily observations showed that extreme‐duration drought became more common, with increases in both the mean and longest dry interval between precipitation events (0.6 ± 0.2, 2.4 ± 0.3 days/decade) and greater interannual variability in these dry intervals. These findings indicate that, against a backdrop of warming and drying, large regions of the western US are experiencing intensification of precipitation variability, with likely detrimental consequences for essential ecosystem services. Plain Language Summary: Changes in precipitation have far‐reaching consequences for socioecological systems, especially in water‐limited regions such as those common in the western US. While the total amount of precipitation is important for these systems, key aspects of precipitation timing, such as the length of dry periods between precipitation events, can strongly influence ecosystem services including ecosystem carbon uptake, productivity for grazing and forage, wildfire frequency, and intensity, and water availability for societal use. In this study, we used daily meteorological data from over three hundred long‐term weather stations across the western US to understand changes in precipitation amounts and timing during the period 1976–2019. In addition to widespread warming, we found overall lower precipitation combined with increasing variability in the size of precipitation events, indicating the western US is not only getting hotter and drier, but that systems are experiencing more year‐to‐year variation in precipitation. We also found that the average time without precipitation has increased during the past 45 years across the southwestern US, and we saw increases in year‐to‐year fluctuations in these dry periods. Together, these changes will likely have large, but still poorly understood, consequences for social and ecological systems of the western US. Key Points: Daily station data reveal longer and more variable dry intervals between rainfall during the period 1976–2019 across much of the western USThe longest dry interval per year increased in 75% of ecoclimatic domains of the western USIn the Desert Southwest and Southwest Rockies/Colorado Plateau, increasing temporal variability of rainfall compounded with reduced rainfall [ABSTRACT FROM AUTHOR]

The 4Kscore® Test (OPKO Diagnostics, Woburn, MA) is a blood test utilized prior to a prostate biopsy to determine a patient's risk of high-grade prostate cancer (PCa) should the biopsy be performed, thus providing critical information in the clinical management of men with a suspicious prostate-specific antigen value or digital rectal examination result. Multiple US and European clinical studies confirmed that a prebiopsy 4Kscore Test has a high degree of discrimination for a subsequent discovery of high-grade (Gleason score ≥7) PCa. The aim of this study was to evaluate the predictive accuracy of the 4Kscore Test to discriminate between patients with and without high-grade PCa based on published clinical validation studies. A systematic review and meta-analysis of the eligible 4Kscore Test clinical validation studies was conducted. The pooled area under the curve (AUC) of the 4Kscore Test as reported from all the studies, and the heterogeneity among these studies were analyzed and repeated for subgroups of the studies. Twelve clinical validation studies were included in the meta-analysis, comprising a total of 11,134 patients. The pooled AUC to discriminate for high-grade PCa for all 12 studies was 0.81 (fixed effects 95% CI, 0.80-0.83). Restricting the analysis to the six publications that used the contemporary 4Kscore Test algorithm led to very similar results (AUC 0.81; 95% CI, 0.79-0.83). Heterogeneity was high among all of the 12 studies, as well as among the six publications that used the contemporary 4Kscore Test (Cochrane's Q test, p 5 0.001 for both); however, in both cases, after exclusion of a single outlying study with a much lower AUC, heterogeneity was no longer significant (p 5 0.08 and p 5 0.21). The pooled estimate of 4Kscore Test discrimination (AUC) for high-grade PCa is .0.80, and is consistent across multiple US and European clinical validation studies. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess the health literacy levels of Hispanic college students. Methods: Participants were students at a major Hispanic-serving university in the southwestern United States. The design was cross-sectional, and data were collected using the Newest Vital Sign in English. Analyses included frequencies and descriptive statistics, simple and multiple logistic regression, and χ²/Fisher exact tests. Results: A total of 331 students participated. The overall Newest Vital Sign mean score was 5.1 (standard deviation 1.18); more than 90% (n = 299) obtained a score equivalent to an "always adequate literacy." A lower percentage than that found by a national survey scored at the "below adequate literacy" level. Language spoken at home was the only covariate that significantly affected test scores (P = 0.01). Conclusions: The overall health literacy level of the participants was higher than the general Hispanic adult population. Investing in the education of Hispanics may help to address disparities in health literacy. [ABSTRACT FROM AUTHOR]

• Plot and plant functional types greenness was extracted from repeat digital images. • Plot greenness closely tracked plot photosynthesis. • Plot greenness was correlated with soil moisture during mid- to late- season. • Plot greenness response to rainfall pulses was delayed under few, large events. • Perennial grass dominated the lagged response under few, large events. Across large portions of the western United States, drought intervals are increasing, often accompanied by larger-magnitude rainfalls. Semi-arid ecosystems are expected to be especially responsive to such temporal repackaging of rainfall because of their high sensitivity to variation in soil moisture. We conducted a field manipulation experiment to evaluate the impacts of summer rainfall repackaging (small/many events to large/few events with a fixed total seasonal amount) on a semi-arid mixed annual/perennial bunchgrass ecosystem. We monitored the sensitivity of plant greenness and productivity to soil moisture under rainfall pulses by combining automated, high-frequency repeat digital images at both plot- and plant functional type- level, whole plot CO 2 uptake measurements, and continuous in-situ soil moisture data. We found that plot greenness was closely correlated with gross primary productivity across all rainfall repackaging treatments (R = 0.82). Plot greenness was weakly correlated to soil moisture at the beginning of the growing season but showed a significant positive correlation during peak and late growing season. Notably, we found a significant lag time of ∼5 days between changes in soil moisture and canopy greenness under large/few events, while there was no lag under small/many events. This time lag was found to be driven by perennial grass greenness and its sensitivity to the relatively deep soil water infiltration observed with large/few rainfall events. Predicting semi-arid grassland responses to soil moisture dynamics under ongoing rainfall repackaging, and subsequent impacts on the regional to global carbon budget, should consider plant communities' phenological characteristics and functional type composition. [ABSTRACT FROM AUTHOR]

Objectives: To explore the performance of laboratory items alone in systemic lupus erythematosus (SLE) classification., Methods: Our cohort consisted of 352 and 385 (control) patients with and without SLE. This study evaluated the performance of the American College of Rheumatology (ACR)-1997, Systemic Lupus International Collaborating Clinics (SLICC)-2012, European League Against Rheumatism (EULAR)/ACR-2019, and Systemic Lupus Erythematosus Risk Probability Index (SLERPI) using laboratory items alone, including blood and urine test results., Results: The median ratio of laboratory items/total items was 66.7%, 75.0%, 60.4%, and 77.4% in ACR-1997, SLICC-2012, EULAR/ACR-2019, and SLERPI, respectively. After including laboratory items alone, the sensitivity of ACR-1997, SLICC-2012, EULAR/ACR-2019, and SLERPI was 31.3% (95% confidence interval [CI]: 26.4%-36.4%), 79.8% (95% CI: 75.3%-83.9%), 75.9% (95% CI: 71.0%-80.2%), and 85.2% (95% CI: 81.1%-88.8%), respectively. We referenced the SLERPI and removed the additional restrictions, i.e., SLICC-2012 criteria only needs to fulfill at least four items (mSLICC-2012) and EULAR/ACR-2019 criteria needs to have ≥ 10 points (mEULAR/ACR-2019) to qualify for SLE classification. The mSLICC-2012 and mEULAR/ACR-2019 criteria, including laboratory items alone, newly identified 13 and 25 patients, respectively. Based on laboratory items alone, the combination of mSLICC-2012, mEULAR/ACR-2019, and SLERPI identified 348 patients with an improved sensitivity of 90.6% (95% CI: 87.1%-93.5%). Patients, who were classified according to the mEULAR/ACR-2019 criteria, all met the other criteria., Conclusion: Incorporating laboratory items alone was clinically feasible to help identify SLE. SLERPI and SLICC-2012, using laboratory items alone, were more worthwhile to promote in the clinic compared with EULAR/ACR-2019. Key Points • Laboratory items play a crucial role in the SLE classification criteria, and incorporating laboratory items alone was clinically feasible to help in the identification of SLE. • The SLERPI and SLICC-2012, using laboratory items alone, were more worthwhile to promote in the clinic compared with EULAR/ACR-2019, and the combination of the two could further improve the sensitivity. • The relative simplicity of evaluating laboratory indices may help nonrheumatologists and inexperienced rheumatologists to identify SLE more quickly, thereby reducing the risk of delayed diagnosis in patients., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Objective: To study whether the current Institute of Medicine (IOM) pregnancy weight gain recommendations vary by pre-pregnancy body mass index (BMI) was suitable to Chinese people., Methods: A study was conducted on 4736 term singleton live birth gravidas, who were diagnosed normal glucose metabolism and delivered in Peking University First Hospital in 2005 and 2009, by reviewing the medical records. Based on the pre-pregnant BMI, the selected cases were divided into 3 groups: low body mass group (BMI < 18.5 kg/m(2), n = 465), normal body mass group (BMI 18.5 - 24.9 kg/m(2), n = 3549), over body mass group (BMI ≥ 25 kg/m(2), n = 722). All the cases were divided into 3 subgroups based on pregnancy weight gain as below, within, and above the IOM recommendations in each pre-pregnant BMI group. Totally 4736 newborns were divided by birth weight into 3 groups: normal birth weight group (weight 2500 - 4000 g, n = 4339), macrosomia group (weight ≥ 4000 g, n = 359) and low birth weight group (weight < 2500 g, n = 38). The difference of age, gestational age, pre-pregnant weight, pre-pregnant BMI and history of delivery of cases between 2005 and 2009 were analyzed. The difference of pregnancy outcome of women whose gestational weight gain was below, within, and above the IOM recommendations was analyzed., Results: (1) Compared to mothers with pregnancy weight gain within IOM recommendations in low body mass group, risk of low birth weight in offspring was elevated tendency with pregnancy weight gain below IOM recommendations (OR = 3.71, 95%CI: 0.97 - 14.12, P = 0.055). (2) In normal body mass group, compared to women with pregnancy weight gain within IOM recommendations, risk of macrosomia in offspring was elevated with pregnancy weight gain above IOM recommendations (OR = 2.14, 95%CI: 1.62 - 2.83, P < 0.01). (3) In over body mass group, compared to women with pregnancy weight gain within IOM recommendations, risk of macrosomia in offspring was elevated (OR = 3.25, 95%CI: 1.65 - 6.39, P = 0.001) and risk of hypertensive disorders complicating pregnancy was high (OR = 1.79, 95%CI: 1.04 - 3.09, P = 0.037) in women with pregnancy weight gain above IOM recommendations., Conclusion: The current IOM pregnancy weight gain recommendations vary by pre-pregnancy BMI may be suitable to Chinese people.