How Does Wind Project Performance Change with Age in the United States?

Wind-plant performance declines with age, and the rate of decline varies between regions. The rate of performance decline is important when determining wind-plant financial viability and expected lifetime generation. We determine the rate of age-related performance decline in the United States wind fleet by evaluating generation records from 917 plants. We find the rate of performance decline to be 0.53%/year for older vintages of plants and 0.17%/year for newer vintages of plants on an energy basis for the first 10 years of operation, which is on the lower end of prior estimates in Europe. Unique to the United States, we find a significant drop in performance by 3.6% after 10 years, as plants lose eligibility for the production tax credit. Certain plant characteristics, such as the ratio of blade length to nameplate capacity, influence the rate of performance decline. These results indicate that the performance decline rate can be partially managed and influenced by policy

Pension Reform in Germany: The Impact on Retirement Decisions

The financing problems beleaguering the public pension system have again shifted the spotlight onto the retirement age. This paper examines the impact of various reform options on the actual retirement choices of older workers. The paper focuses in particular on the long-term implications of the changes implemented in pension legislation since 1992 and the reform options discussed by the German Social Security Reform Commission installed in 2002, the so called "Rürup Commission". Our simulations show that the early-retirement pension adjustment factors introduced by the 1992 pension reform will, in the long term, raise the average effective age of retirement for men by somewhat less than two years. The across-the-board two-year increase in all the relevant age limits proposed by the "Rürup Commission" would raise the effective average age of retirement of men by about eight months. If the actuarial adjustment factor is increased from 3.6% to 6% per year, the effective average retirement age rises by almost two years. The effects are considerably weaker for women.

Pension Reform in Germany: The Impact on Retirement Decisions

The financing problems beleaguering the public pension system have again shifted the spotlight onto the retirement age. This paper examines the impact of various reform options on the actual retirement choices of older workers. The paper focuses in particular on the long-term implications of the changes implemented in pension legislation since 1992 and the reform options discussed by the German Social Security Reform Commission installed in 2002, the so called R?rup Commission'. Our simulations show that the early-retirement pension adjustment factors introduced by the 1992 pension reform will, in the long term, raise the average effective age of retirement for men by somewhat less than two years. The across-the-board two-year increase in all the relevant age limits proposed by the R?rup Commission' would raise the effective average age of retirement of men by about eight months. If the actuarial adjustment factor is increased from 3.6% to 6% per year, the effective average retirement age rises by almost two years. The effects are considerably weaker for women.

Serum vitamin A and other nutritional parameters in children with congenital heart disease

Objective: To compare the weight for age, the serum albumin and vitamin A of children with congenital heart disease (CHD) with those of age and sex matched controls without CHD.Methods: Consecutive children diagnosed to have CHD by echocardiography who were afebrile two weeks prior were recruited. Subjects who had bronchopneumonia were noted. Their weights, haematocrit, serum albumin and vitamin A were measured. Variables were compared betweensubjects and controls. Vitamin A was measured by high performancechromatography.Results: Thirty eight subjects with mean age of 3.6 ± 4.3 years and 40 controls with mean age of 3.6 ± 4.8 years were recruited. Fifteen (39.5 %) subjects had bronchopneumonia while 14/38 (36.8 %) and 4/36(11.1 %) subjects and controls respectively were undernourished, p = 0.014. The mean serum vitamin A values in subjects 0.86 ± 0.13 mmol/l and controls 0.87 ± 0.16 mmol/l was not significantly different, P = 0.76. Serum albumin of subjects and controls were 3.5 ± 0.5 and 3.6 ± 0.43  respectively, p = 0.60 Conclusion: There was no significant difference in serum vitamin A and albumin in subjects and controls. However, significantly more children with CHD than controls were undernourished.Keywords: congenital heart disease; vitamin A; serum albumin

Patient Relevant Outcomes after total hip replacement. A comparison between different surgical techniques

OBJECTIVE: To investigate differences in pre- and postoperative patient-relevant outcome between hybrid total hip replacement (THR) and cemented THR in patients with primary osteoarthritis (OA). METHODS: 245 consecutive patients were included in the study. 68 of the patients (mean age 62) were operated on with hybrid THR and 177 (mean age 74) were operated on with cemented THR. All patients were investigated preoperatively and 0.5, 1 and 3.6 years postoperatively with two self-administered questionnaires, SF-36 and WOMAC (Western Ontario and MacMaster Universities Osteoarthritis Index, LK 3.0). RESULTS: Preoperatively, there was a difference in the SF-36 subscales RP (role physical) and GH (general health) where the patients with the hybrid THR attained better scores. At 3.6-years the patients with the hybrid THR reached better scores in all SF-36 subscales except BP (bodily pain) and GH. Further, they had better scores in WOMAC function. However, after adjusting for age, sex, follow-up time and baseline values there were no differences in outcome between the two different surgical techniques. CONCLUSION: This medium term (3–5 years), controlled, open cohort study, using patient-relevant outcome measures, did not reveal any differences between hybrid THR and cemented THR for OA at 3.6 years after surgery. Since the study had 75–94% power to detect the clinically significant score difference of 10 points, we suggest that any difference in outcome between these two methods is small and may require a large-scale, blinded, randomized trial to show

The effect of ethnic factor on cephalic index in 17-20 years old females of north of Iran [Efecto del factor étnico en el índice cefálico en mujeres entre 17 y 20 años de edad del norte de Irán]

Cephalic index and head shape are affected by geographical, gender, age, racial and ethnic factors. This study was carried out to determine cephalic index and head shape in 17-20 years old female in Gorgan, North of Iran. This descriptive and cross sectional study is undertaken on 410 normal 17-20 years old female (Turkman group: n=203, Fars group: n=207). The study was done by classic cephalometry in Gorgan North of Iran. Means and SD of cephalic index was 85 ± 4.5 and 82.8 ± 3.6 in native Fars and Turkman groups, respectively. Dominant and rare type of head shape in native Fars group were hyperbrachycephalic (53.6%) and dolichocephalic (15%), and in Turkman group were brachycephalic (58.1%) and dolichocephalic (0.05%), respectively. With noticing of our results and other studies in the world, we can conclude that the role of ethnic factor on head dimensions. © 2007 Sociedad Chilena de Anatomía

Prescription of the first prosthesis and later use in children with congenital unilateral upper limb deficiency: A systematic review

Background: The prosthetic rejection rates in children with an upper limb transversal reduction deficiency are considerable. It is unclear whether the timing of the first prescription of the prosthesis contributes to the rejection rates. Objective: To reveal whether scientific evidence is available in literature to confirm the hypothesis that the first prosthesis of children with an upper limb deficiency should be prescribed before two years of age. We expect lower rejection rates and better functional outcomes in children fitted at young age. Methods: A computerized search was performed in several databases (Medline, Embase, Cinahl, Amed, Psycinfo, PiCarta and the Cochrane database). A combination of the following keywords and their synonyms was used: "prostheses, upper limb, upper extremity, arm and congenital''. Furthermore, references of conference reports, references of most relevant studies, citations of most relevant studies and related articles were checked for relevancy. Results: The search yielded 285 publications, of which four studies met the selection criteria. The methodological quality of the studies was low. All studies showed a trend of lower rejection rates in children who were provided with their first prosthesis at less than two years of age. The pooled odds ratio of two studies showed a higher rejection rate in children who were fitted over two years of age ( pooled OR 3.6, 95% CI 1.6-8.0). No scientific evidence was found concerning the relation between the age at which a prosthesis was prescribed for the first time and functional outcomes. Conclusion: In literature only little evidence was found for a relationship between the fitting of a first prosthesis in children with a congenital upper limb deficiency and rejection rates or functional outcomes. As such, clinical practice of the introduction of a prosthesis is guided by clinical experience rather than by evidence-based medicine

Associations Between Vascular Risk Across Adulthood and Brain Pathology in Late Life: Evidence From a British Birth Cohort

IMPORTANCE: Midlife vascular risk burden is associated with late-life dementia. Less is known about if and how risk exposure in early adulthood influences late-life brain health. OBJECTIVE: To determine the associations between vascular risk in early adulthood, midlife, and late life with late-life brain structure and pathology using measures of white matter–hyperintensity volume, β-amyloid load, and whole-brain and hippocampal volumes. DESIGN, SETTING, AND PARTICIPANTS: This prospective longitudinal cohort study, Insight 46, is part of the Medical Research Council National Survey of Health and Development, which commenced in 1946. Participants had vascular risk factors evaluated at ages 36 years (early adulthood), 53 years (midlife), and 69 years (early late life). Participants were assessed with multimodal magnetic resonance imaging and florbetapir-amyloid positron emission tomography scans between May 2015 and January 2018 at University College London. Participants with at least 1 available imaging measure, vascular risk measurements at 1 or more points, and no dementia were included in analyses. EXPOSURES: Office-based Framingham Heart study–cardiovascular risk scores (FHS-CVS) were derived at ages 36, 53, and 69 years using systolic blood pressure, antihypertensive medication usage, smoking, diabetic status, and body mass index. Analysis models adjusted for age at imaging, sex, APOE genotype, socioeconomic position, and, where appropriate, total intracranial volume. MAIN OUTCOMES AND MEASURES: White matter–hyperintensity volume was generated from T1/fluid-attenuated inversion recovery scans using an automated technique and whole-brain volume and hippocampal volume were generated from automated in-house pipelines; β-amyloid status was determined using a gray matter/eroded subcortical white matter standardized uptake value ratio threshold of 0.61. RESULTS: A total of 502 participants were assessed as part of Insight 46, and 463 participants (236 male [51.0%]) with at least 1 available imaging measure (mean [SD] age at imaging, 70.7 [0.7] years; 83 β-amyloid positive [18.2%]) who fulfilled eligibility criteria were included. Among them, FHS-CVS increased with age (36 years: median [interquartile range], 2.7% [1.5%-3.6%]; 53 years: 10.9% [6.7%-15.6%]; 69 years: 24.3% [14.9%-34.9%]). At all points, these scores were associated with smaller whole-brain volumes (36 years: β coefficient per 1% increase, −3.6 [95% CI, −7.0 to −0.3]; 53 years: −0.8 [95% CI, −1.5 to −0.08]; 69 years: −0.6 [95% CI, −1.1 to −0.2]) and higher white matter–hyperintensity volume (exponentiated coefficient: 36 years, 1.09 [95% CI, 1.01-1.18]; 53 years, 1.02 [95% CI, 1.00-1.04]; 69 years, 1.01 [95% CI, 1.00-1.02]), with largest effect sizes at age 36 years. At no point were FHS-CVS results associated with β-amyloid status. CONCLUSIONS AND RELEVANCE: A total of 502 participants were assessed as part of Insight 46, and 463 participants (236 male [51.0%]) with at least 1 available imaging measure (mean [SD] age at imaging, 70.7 [0.7] years; 83 β-amyloid positive [18.2%]) who fulfilled eligibility criteria were included. Among them, FHS-CVS increased with age (36 years: median [interquartile range], 2.7% [1.5%-3.6%]; 53 years: 10.9% [6.7%-15.6%]; 69 years: 24.3% [14.9%-34.9%]). At all points, these scores were associated with smaller whole-brain volumes (36 years: β coefficient per 1% increase, −3.6 [95% CI, −7.0 to −0.3]; 53 years: −0.8 [95% CI, −1.5 to −0.08]; 69 years: −0.6 [95% CI, −1.1 to −0.2]) and higher white matter–hyperintensity volume (exponentiated coefficient: 36 years, 1.09 [95% CI, 1.01-1.18]; 53 years, 1.02 [95% CI, 1.00-1.04]; 69 years, 1.01 [95% CI, 1.00-1.02]), with largest effect sizes at age 36 years. At no point were FHS-CVS results associated with β-amyloid status

RARE-30. PEDIATRIC GLIOBLASTOMA IN THE POST-TEMOZOLOMIDE ERA: OUTCOMES AND CHARACTERISTICS

Abstract INTRODUCTION Glioblastoma (GBM) is the most common brain tumor, however, is a rare occurrence in children and is poorly characterized. We evaluated the characteristics and outcomes of pediatric GBM (pGBM). METHODS Retrospective analysis of pediatric (age< 18) patients diagnosed with GBM undergoing first glioblastoma resection at our brain tumor center (2005- 2016). RESULTS From 1457 GBM patients, we identified twenty-four (1.65%) pGBMs (Median Age=9 years, Females=45.8%). Median overall survival (OS) was 32.1 months, while the median progression-free survival was 11.5 months. The commonest symptoms at presentation were headaches (54.2%,n=13) and motor symptoms (50%,n=12). Mean tumor diameter was 4.5 cm and 25% of the cohort underwent gross total resection (GTR) of their tumor. Univariate analysis revealed median OS significantly associated with tumor extent of resection (GTR=56.4 months; STR/Biopsy=13.7 months, p=0.001), age at surgery (>10 years=43.9 months, < 10 years= 17.2 months, p=0.01), tumor size (> 4cm= 9.1 months, < 4cm=56.9 months, p=0.01),motor symptoms at presentation (present=14.9 months, absent=41.04 months, p=0.02) and infratentorial tumors (infratentorial=17.4 vs supratentorial=53.4 months, p=0.02). Multivariate analysis revealed GTR (HR 0.2[95% CI 0.07–0.72]; p=0.03), Age >10 years (HR 0.6[95% CI 0.02–0.64]; p=0.002), tumor >4 cm (HR 2.89[95% CI 1.88–4.11]; p=0.001) and EGFR amplification (HR 3.48[95% CI 0.82–17.4]; p=0.005) to be independent predictors of OS. Comparing patients under and over 10 years, we found that older patients had smaller tumors at presentation (4.9 vs 3.6 cms, p=0.03), greater rates of preoperative temozolomide (n=1,7.7% vs n=6, 54.5%) and bevacizumab (n=1,7.7% vs n=4, 36.4%) treatment, and lower rates of EGFR amplification (66.7% vs 11.1%) that could explain survival disparities between groups. CONCLUSION Motor symptoms, larger tumors at presentation and tumor EGFR amplification may be indictive of poorer outcomes in pGBM. However, maximal tumor resection, aggressive chemoradiation and tumor presentation at age >10 years may confer better prognosis in these patients

High serum osteopontin levels are associated with prevalent fractures and worse lipid profile in post-menopausal women with type 2 diabetes

Purpose: Patients with type 2 diabetes (T2DM) have increased fracture risk. Osteopontin (OPN) is a protein involved in bone remodeling and inflammation. The aim of this study was to evaluate the association of OPN with fracture prevalence and with metabolic parameters in post-menopausal women with T2DM. Methods: Sixty-four post-menopausal women with T2DM (age 67.0 ± 7.8 years, diabetes duration 8.9 ± 6.7 years), enrolled in a previous study, were followed up (3.6 ± 0.9 years). Previous fragility fractures were recorded. The FRAX score (without BMD) was calculated and biochemical parameters (plasma glucose, HbA1c, lipid profile and renal function) were assessed. Serum 25OH-vitamin D, calcium, PTH and OPN were evaluated at baseline. The association between OPN and fracture prevalence at baseline was evaluated by a logistic model. Results: OPN levels were higher in patients with previous fractures (n.25) than in patients without previous fractures at baseline (n.39) (p = 0.006). The odds of having fractures at baseline increased by 6.7 (1.9–31.4, 95% CI, p = 0.007) for each increase of 1 ng/ml in OPN levels, after adjustment for vitamin D and HbA1c levels. Fracture incidence was 4.7%. Higher OPN associated with a decrease in HDL-cholesterol (p = 0.048), after adjustment for age, basal HDL-cholesterol, basal and follow-up HbA1c and follow-up duration. 25OH-vitamin D associated with an increase in FRAX-estimated probability of hip fracture at follow-up (p = 0.029), after adjustment for age, 25OH-vitamin D and time. Conclusions: In post-menopausal women with T2DM, OPN might be a useful marker of fracture and worse lipid profile