Microbial consortia in riverbed substrates and their extracellular matrix (biofilms) play a key role in phosphorus (P) entrapment. When P entrapment saturates, the benthic compartment changes from a P sink to a P source thus increasing eutrophication risk. P entrapment saturation is expected to differ between intracellular and extracellular P entrapment and between different magnitudes and durations of P inputs. We studied biofilm P-entrapment following short (48 h) and long (14 days) P loading events in stream bypass flumes supplied with a gradient of dissolved P concentrations. This allowed us to link local biofilm processes in sediments to potential effects on river self-purification, via quantifying the P removal efficiency in the flumes. We found that in short-term events, biofilms develop intracellular mechanisms to cope with P inputs, while long-term events and high P inputs suppress the intracellular uptake mechanisms and increase the prevalence of extracellular entrapment. Specifically, long-term events lowered the threshold for intracellular P entrapment saturation, and decreased the ratio between intracellular and extracellular entrapment resulting in lower removal efficiency for dissolved phosphorus. Our results highlight the risk that aquatic ecosystems may face as the ratio of intracellular to extracellular P entrapment decreases, which may reduce their ability to deal with P inputs, thereby increasing risks of eutrophication.

Tidal dynamics are a well-known driver of mangrove distribution, with most predictive measures using some form of tidal parameter (tidal plane or hydroperiod) to define mangrove extent. However, these methods often fail to consider the causative reason why mangroves thrive or perish at a specific elevation or how mangrove survivability thresholds can differ across a species\' lifecycle. The lack of understanding of the drivers influencing mangrove establishment has resulted in poor success rates for mangrove restoration and creation projects worldwide. A novel mangrove lifecycle model that uses a multi-forcing threshold approach is proposed to simulate Avicennia marina viability across establishment and development phases. The lifecycle model includes critical threshold stages for reproduction, seed dispersal, seedling establishment and development, and mature tree survival. The model was validated at 37 sites in eastern Australia to predict mangrove extent across various estuary types and tidal dynamic conditions. The model accurately calculated the upper (RMSE = 0.0676, R2 = 0.8932) and lower (RMSE = 0.0899, R2 = 0.7417) mangrove surface elevations, providing physiological reasoning for establishment and development. Based on the various conditions tested, the model results highlight the highly dynamic spatial and temporal conditions where Avicennia forests thrive. It was found that stressors influencing mangrove establishment were the primary factor for mangrove extent across all sites. However, estuarine typology is important in forcing threshold limits and establishment opportunities. Estuaries with limited tidal decay (from the oceanic forcing) provide more opportunities for mangroves to establish than estuaries with significant tidal attenuation. Regardless of estuary typology, all sites tested had substantial spatial variability through time. Results from the lifecycle model suggest that mature Avicennia forests establish and thrive under a wide range of hydrologic conditions. This resilience suggests that mature mangroves may be able to withstand increases in climatic and hydrologic pressures via biophysical adaptations, although the upper thresholds and acceptable rates of change are difficult to predict. Overall, this study highlights the value of a new causal method for estimating mangrove extent across various lifecycle stages, locations, and time periods.

OBJECTIVE: To test trial and longitudinal known group discrimination of thresholds of meaning for improvement and health states of the ASAS Health Index (ASAS HI) in patients with active axSpA treated in a randomized study.
METHODS: Data from baseline and week 48 from the tight-controlled, treat-to-target trial TICOSPA study were used. The performance of different thresholds to assess change or health states of the ASAS HI were evaluated between arms and against changes in patients\' relevant outcomes and various external responder criteria. Analyses were performed by comparing the mean values t-tests or proportion of responders of continuous and dichotomous external criteria respectively. Trial discrimination of the ASAS HI thresholds were assessed by odds ratios and Phi coefficient in a large number of potential ASAS HI thresholds. Differences in health states in relevant external outcomes between ASAS HI responders and non-responders was assessed by comparing the best performing improvement and state thresholds by using t-tests and chi-square, as appropriate. Missing data on outcomes was handled by non-responder imputation (NRI).
RESULTS: All 160 patients had available ASAS HI data. Trial discrimination was larger for absolute ASAS HI change of ≥2.0, ≥2.5, and ≥3.0 points followed by ASAS HI 20 % improvement. Odds ratio ranged between 1.27 and 1.75 for absolute and between 1.0 and 1.64 for relative improvement outcomes. Longitudinal discrimination of ASAS HI improvement ≥30 % or ≥ 3.0 points had a larger reduction in patient global and disease activity and reached more often remission compared to patients with no significant improvement in global functioning. Patients who achieved ASAS HI ≤ 5.0 compared with patients who did not achieve such states were more likely to have ASAS partial remission, ASDAS inactive disease or ASDAS low activity at week 48.
CONCLUSIONS: The data-driven thresholds of the ASAS HI identified in a longitudinal observational setting perform well in the context of a randomized trial.

To effectively address odor control issues at sites contaminated with halogenated hydrocarbons, it is essential to establish an odor risk prediction system for evaluating potential risks that may impact future planning. This research focuses on a representative halogenated hydrocarbon-contaminated site, examining the spatial and temporal distribution characteristics of key pollutants in soil gas. By analyzing odor contribution rates, the study identifies significant odorants in soil gas, which enables the derivation of both probabilistic and deterministic safety thresholds for soil and groundwater based on olfactory effects. The findings indicate that 1,1-dichloroethylene, vinyl chloride, chloroform, and 1,1-dichloroethane are prevalent throughout the contaminated site, displaying elevated concentration levels and substantially influencing the overall contamination extent. These substances are highlighted as critical pollutants requiring attention. Correlation analysis (P < 0.05) reveals a strong relationship between the concentrations of vinyl chloride, 1,1-dichloroethane, and chloroform with groundwater depth and air temperature. Additionally, the analysis of odor activity values (OAV) identified 1,1-dichloroethene, 1,4-dichlorobenzene, chlorobenzene, chloroform, and vinyl chloride as key olfactory factors at the site. The corresponding probabilistic safety thresholds are 0.68, 1.65, 0.50, 7.87, and 3.72 mg kg-1 for soil, and 9.29, 3.46, and 1.09, 69.55, and 47.01 mg L-1 for groundwater, respectively. Among them, the odor risks of chlorobenzene and 1,1-dichloroethylene warrant more attention than soil contamination risks; regarding 1,4-dichlorobenzene, it is recommended to concurrently consider odor risks during human health risk assessment; as for vinyl chloride and chloroform, their odor risks can be largely eliminated based on human health-oriented pollution management.

UNASSIGNED: Ineffective erythropoiesis and subsequent anemia as well as primary and secondary (transfusional) iron overload are key drivers for morbidity and mortality outcomes in patients with β-thalassemia.
UNASSIGNED: In this review, we highlight evidence from observational studies evaluating the association between measures of anemia and iron overload versus outcomes in both non-transfusion-dependent and transfusion-dependent forms of β-thalassemia.
UNASSIGNED: Several prognostic thresholds have been identified with implications for patient management. These have also formed the basis for the design of novel therapy clinical trials by informing eligibility and target endpoints. Still, several data gaps persist in view of the challenge of assessing prospective long-term outcomes in a chronic disease. Pooling insights on the prognostic value of different measures of disease mechanism will be key to design future scoring systems that can help optimize patient management.

Temperature extremes exert a significant influence on terrestrial ecosystems, but the precise levels at which these extremes trigger adverse shifts in vegetation productivity have remained elusive. In this study, we have derived two critical thresholds, using standard deviations (SDs) of growing-season temperature and satellite-based vegetation productivity as key indicators. Our findings reveal that, on average, vegetation productivity experiences rapid suppression when confronted with temperature anomalies exceeding 1.45 SD above the mean temperature during 2001-2018. Furthermore, at temperatures exceeding 2.98 SD above the mean, we observe the maximum level of suppression, particularly in response to the most extreme high-temperature events. When Earth System Models are driven by a future medium emission scenario, they project that mean temperatures will routinely surpass both of these critical thresholds by approximately the years 2050 and 2070, respectively. However, it is important to note that the timing of these threshold crossings exhibits spatial variation and will appear much earlier in tropical regions. Our finding highlights that restricting global warming to just 1.5°C can increase safe areas for vegetation growth by 13% compared to allowing warming to reach 2°C above preindustrial levels. This mitigation strategy helps avoid exposure to detrimental extreme temperatures that breach these thresholds. Our study underscores the pivotal role of climate mitigation policies in fostering the sustainable development of terrestrial ecosystems in a warming world.

UNASSIGNED: Brain natriuretic peptide (BNP)/N-terminal-pro hormone brain natriuretic peptides (NT-proBNP) enable risk stratification, diagnosing, and monitoring of heart failure patients. An additional prognostic value for BNP/NT-proBNP in nonheart failure patients and general population cohorts is described in the literature, but specific cut-off levels are only described for heart failure patients.
UNASSIGNED: This study aimed to determine thresholds for risk stratification in nonheart failure patients.
UNASSIGNED: Based on the Essen Coronary Artery Disease registry we excluded patients with known heart failure or elevated BNP/NT-pro BNP levels. The resulting cohort was divided into a derivation and validation cohort using random sampling. The prognostic value of BNP/NT-proBNP of incident mortality was evaluated in the derivation cohort using univariate and multivariable cox regression analysis. In receiver operating characteristic analysis and corresponding area under the curve the optimal threshold was determined using Youdens J index. The findings were verified in the validation cohort.
UNASSIGNED: A total of 3,690 patients (age 62.9 ± 12.5 years, 71% male, 68% patients with coronary artery disease) were included. During a mean follow-up of 2.6 ± 3.4 years (median 1.2 [IQR: 0.4-2.88]), 169 deaths of any cause occurred. Based on Youden\'s J index, BNP-thresholds of 9.6 and 29pg/ml and NT-proBNP thresholds of 65 and 77pg/ml for men and women, respectively, were determined. BNP/NT-proBNP levels above these thresholds were associated with increased mortality in the derivation cohort (HR: 2.44 [95% CI: 1.32-4.53], P = 0.005). The predictive value was confirmed in the validation cohort (HR: 2.78 [95% CI: 1.26-6.14], P = 0.01).
UNASSIGNED: We here describe sex-specific BNP/NT-proBNP thresholds that allow prediction of impaired survival in patients without heart failure, independent of traditional cardiovascular risk factors.

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Many of South Africa\'s current water quality problems have been attributed to diffuse pollution derived from poorly regulated land use/land cover (LULC) transformations. To mitigate these impacts, the preservation of an adequate amount of natural vegetation within catchment areas is an important management strategy. However, it is not clear how much natural vegetation cover is required to provide adequate levels of protection, nor at which scale(s) this strategy would be most effective. To investigate the possibility of estimating minimum thresholds of natural vegetation required to protect water resources, regression analysis was used to model relationships between water quality (measured using Nemerow\'s Pollution Index) and metrics of natural vegetation at multiple scales across a sample of sub-catchments located along the western, southern, and south-eastern coast of South Africa. With conspicuous outliers removed, the models were able to explain up to 82 % of the variability in the relationship between land use and water quality. Moreover, a statistically significant, nonlinear, and inverse relationship was found between proportions of natural vegetation cover and pollution levels. This relationship was strongest when measured (1) across the whole catchment and (2) within a 200 m riparian buffer zone. The models further indicated that approximately 80 to 90 % natural vegetation cover was necessary at these scales to maintain water quality at ecologically acceptable levels. Additional nonlinear thresholds estimated using breakpoint analysis suggested that if proportions of natural vegetation fall below 45 % (across the whole catchment) and 60 % (within a 200 m riparian buffer zone) a dramatic increase in pollution levels can be expected. The estimated thresholds are recommended as guidelines that can be used to inform integrated land and water resources management strategies aimed at protecting water quality in the study area. Likewise, the methods described are recommended for the estimation of similar thresholds in other regions.

The aim of this work is to define harmonized reference conditions and assessment thresholds for selected criteria elements of the Marine Strategy Framework Directive (MSFD) Descriptor 5 (Eutrophication) in the Eastern Mediterranean Sea and to test if a tool for integrated assessment of the status of marine systems can be used as a common methodological approach. In this frame, we tested two statistical approaches in order to set threshold values for four criteria of Descriptor 5: nutrients, chlorophyll a, transparency and dissolved oxygen in the bottom waters. It is noteworthy that this work revealed the need to apply common procedures in data treatment and assessment evaluation. This is the first attempt to set common methods for the assessment of eutrophication in the Eastern Mediterranean, which is essential in marine environments, especially those shared by several countries. To this end, we have applied common criteria and metrics and established thresholds \"Good\" and \"Moderate\" for nutrients, chlorophyll a, transparency and dissolved oxygen in the bottom waters for the different Water Types of the Adriatic and Aegean Seas (I, II, IIIW, IIIE), based on datasets provided by Italy, Slovenia, Croatia and Greece. The selected criteria elements were common for all countries, providing a unified approach to GES assessment of two case study areas: the Adriatic Sea and the Saronikos Gulf. Dissolved Inorganic Nitrogen (DIN) threshold values of 15.6, 6.85, 1.61 and 2.11 μmol L-1 were set for the Water Types I, II, IIIW and IIIE, respectively. We also tested if an aggregation tool for GES assessment, such as Nested Environmental status Assessment Tool (NEAT), could be used as a common methodological approach. The comparison of NEAT with TRIX showed good comparability. In this end, NEAT can be used as a useful and much needed assessment tool for assessing eutrophication status of the marine.