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Background: Fetal brain magnetic resonance imaging (MRI)‐based gestational age prediction has been widely used to characterize normal fetal brain development and diagnose congenital brain malformations. Purpose: The uncertainty of fetal position and external interference leads to variable localization and direction of the fetal brain. In addition, pregnant women typically concentrate on receiving MRI scans during the fetal anomaly scanning week, leading to an imbalanced distribution of fetal brain MRI data. The above‐mentioned problems pose great challenges for deep learning‐based fetal brain MRI gestational age prediction. Methods: In this study, a pyramid squeeze attention (PSA)‐guided dynamic feature fusion CNN (PDFF‐CNN) is proposed to robustly predict gestational ages from fetal brain MRI images on an imbalanced dataset. PDFF‐CNN contains four components: transformation module, feature extraction module, dynamic feature fusion module, and balanced mean square error (MSE) loss. The transformation and feature extraction modules are employed by using the PSA to learn multiscale and multi‐orientation feature representations in a parallel weight‐sharing Siamese network. The dynamic feature fusion module automatically learns the weights of feature vectors generated in the feature extraction module to dynamically fuse multiscale and multi‐orientation brain sulci and gyri features. Considering the fact of the imbalanced dataset, the balanced MSE loss is used to mitigate the negative impact of imbalanced data distribution on gestational age prediction performance. Results: Evaluated on an imbalanced fetal brain MRI dataset of 1327 routine clinical T2‐weighted MRI images from 157 subjects, PDFF‐CNN achieved promising gestational age prediction performance with an overall mean absolute error of 0.848 weeks and an R2$R^2$ of 0.904. Furthermore, the attention activation maps of PDFF‐CNN were derived, which revealed regional features that contributed to gestational age prediction at each gestational stage. Conclusions: These results suggest that the proposed PDFF‐CNN might have broad clinical applicability in guiding treatment interventions and delivery planning, which has the potential to be helpful with prenatal diagnosis. [ABSTRACT FROM AUTHOR]

Background: Many infertile couples undergo assisted reproductive technology (ART) to increase pregnancy chances, with many of them experiencing psychosocial distress. Although research has been performed on women's experiences of ART, there is limited focus on men. Objective: This systematic review consolidated and synthesized men's experiences with ART to better understand their needs and challenges to support them. Search Strategy: Nine electronic databases were searched from the inception date until November 2022. Selection Criteria: This review included published and unpublished primary studies with qualitative methodologies exploring men's experiences with ART. Data Collection and Analysis: The screening of studies, methodological assessment, data extraction, and analysis were conducted by two reviewers independently. The data were thematically synthesized. Main Results: Fifteen studies were included. An overarching theme of "despair to destiny" was identified, with four synthesized themes: (1) "the roller coaster ride," (2) "what made it from bad to worse?", (3) "what kept men going?", and (4) "hopeful for the future." Conclusion: Men undergoing ART experienced struggles, a transition of emotions, and a need for support as they attempted to cope with unknowns while remaining hopeful for future outcomes. There is a need for health care interventions and policies to address the issue to improve the well‐being of male ART patients. Interventions should be tailored to the specific support groups that cater to the emotional and informational needs of male ART patients. Future research should focus on the influence of cultural sensitivities on men's ART experiences, to tailor support programs to address their psychological needs during ART. Synopsis: Health care interventions and policies should support men undergoing assisted reproductive technology and address treatment‐related psychosocial stress to improve their well‐being. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between preconception maternal retinal arteriolar calibre and fetal growth. Design, setting and population: A hospital‐based, prospective preconception cohort including 369 women with a singleton live birth. Methods: We collected detailed information on sociodemographic status, pregnancy history and lifestyle, and performed retinal imaging at the preconception visit. Main outcome measures: We retrieved medical records documenting fetal growth biometrics (e.g., abdominal circumference [AC], head circumference [HC], femur length [FL]) at 11–13, 18–21, 24–28, and 32–34 weeks throughout pregnancy. We then computed the z scores for all fetal growth biometrics from 14 weeks of gestation where data were available, referencing the INTERGROWTH‐21st fetal growth chart. We used a linear mixed model to estimate the association between maternal preconception retinal arteriolar calibre and fetal growth biometrics z scores throughout pregnancy, with random intercept accounting for repeated measures within individuals. We then performed a multivariable linear regression of maternal preconception retinal arteriolar calibre and z score changes for all fetal growth biometrics between 24–28 weeks and 32–34 weeks of gestation, after full adjustment. Results: Maternal preconception generalised retinal arteriolar narrowing was consistently associated with a reduction in fetal AC z scores (−0.34; 95% CI −0.66 to −0.03) throughout pregnancy. In addition, women with preconception generalised retinal arteriolar narrowing tended to have significantly reduced z score changes in AC (−0.41; 95% CI −0.90 to −0.001) and fetal FL (−0.55; 95% CI −1.00 to −0.10) between 24–28 weeks and 32–34 weeks of gestation, respectively. Conclusions: Our findings suggest that women with narrower preconception retinal arterioles had smaller fetuses, evidenced by reductions in AC and FL z score throughout pregnancy. Linked article: This article is commented on by Veronica Giorgione, pp. 288‐289 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17666 [ABSTRACT FROM AUTHOR]

Layered rocks are heterogeneous media composed of multiscale minerals with contrasting geomechanical properties. It remains unclear how the mechanical responses of constituent minerals among different adjacent layers vary in a microscale. Based on the grid nanoindentation tests assisted by high‐resolution scanning electron microscopy and energy‐dispersive spectroscopy techniques, we quantified the mechanical responses of various minerals in an interbedded sandstone‐mudstone core sample and provided visual mineralogies and indentation patterns of different adjacent layers. Results show that the Young's modulus, hardness, and elasticity index of quartz and dolomite decrease, whereas their fracture toughness and plastic work ratio increase from the sandstone layer to the mudstone layer. Quartz displays elastic‐dominated deformations in the sandstone layer whereas transforms into medium‐plastic deformations in the mudstone layer. The mean values of Young's modulus, hardness, and elasticity index of quartz in the sandstone layer are 1.28, 2.00, and 1.56 times higher than that in the mudstone layer, respectively. Dolomite and phyllosilicate minerals show prominently plastic‐dominated deformations in each layer. When an indenter encounters multiple minerals simultaneously, the mechanical responses are determined by the softer phases and irregular indent impressions are generated. Shear and radical cracks are prone to occur in the elastic‐dominated minerals, while chipping damage is induced in the plastic‐dominated minerals. This work provides new insights and fundamental understandings in geomechanical properties contrasts in multilayered rocks, and can facilitate the geomechanical modeling and upscaling schemes in multilayered formations. Plain Language Summary: Multilayered formations often consist of lithological layers with significant variations in geomechanical properties. In Ordos Basin, China, the multilayered formations not only contain a large amount of unconventional oil and gas resources, but also provide a potentially safe and economic trap for CO2 geological storage. The geomechanical contrast between layers generally controls the rock heterogeneity and fracture containment in layered rocks. However, the mechanical response of an individual layer such as the pure sandstone on layered rocks is difficult to quantify on core samples since the thinly interbedded layer is less prone to extract for the standard mechanical tests. Moreover, it is infeasible to interpret the geomechanical heterogeneity in microscale by well logging results restricted by its resolution. Hence, we used nanoindentation tests combined with scanning electron microscopy and energy‐dispersive spectroscopy techniques to explore the mechanical properties and deformation behaviors of the microsized minerals among adjacent layers including sandstone, mudstone, and their interfaces. This study is expected to provide direct visual insights into the mechanical responses and contrasts among various minerals in adjacent layers, and will possibly facilitate the rock‐physics modeling and upscaling, which can help to guide for the hydraulic fracturing designing, waste water injection, and CO2 injection for carbon capture and storage, etc. Key Points: Geomechanical responses of individual minerals and multiple minerals were quantified in different layers of an interbedded core sampleElasticity index of quartz and dolomite decreases whereas fracture toughness and plastic work ratio increase from sandstone to mudstoneMechanical responses of multiple minerals are determined by the softer phases, resulting in irregular indent impressions in each layer [ABSTRACT FROM AUTHOR]

Long‐range transport and vertical distribution of aerosols are important factors for assessing the uncertainty in aerosol radiative forcing. This paper reveals the vertical distribution and trends of aerosol optical properties in China using 15 years of Cloud‐Aerosol Lidar with Orthogonal Polarization (CALIOP) data. The Hybrid Single‐Particle Lagrangian integrated trajectory model was used to analyze the transport and trends of aerosols in the layer with the highest occurrence frequencies of dust, polluted dust, polluted continental and elevated smoke aerosols. The results indicated that (a) there were significant regional and seasonal differences in the vertical distribution of aerosols. The aerosol optical depth (AOD) trend in a given region depends on the changes in the aerosol type with the highest frequency and the layer corresponding to the largest AOD in the vertical profile. The frequency of polluted dust aerosols was the highest in Beijing‐Tianjin‐Hebei (BTH) and Central China. The considerable decrease in the 0–2 km AOD led to a significant trend of the column AOD. (b) The changes of AOD and main aerosol types in a region are also affected by the changes of aerosol sources and long‐range transport pathways. In the BTH, dust aerosols originated from the Mongolian Plateau, accounting for 57.88% of the total trajectories. The Pearl River Delta was dominated by elevated smoke aerosols, with trajectories mainly originating from the Myanmar and Vietnam, accounting for 27.38% and 29.59%, respectively. The trend of 15‐year backward trajectories of dust aerosols on the Tibetan Plateau indicated that the trajectory from India is increasing. Plain Language Summary: Aerosols are one of the main factors affecting global climate change, influencing global radiation through direct and indirect effects. Long‐range transport aerosols and their vertical distribution are important factors for assessing the uncertainty in aerosol radiative forcing. At present, there is limited research on the vertical distribution and transport pathways of different types of aerosols in multiple regions over China. Considering that aerosols in different regions of China exhibit large vertical distribution and transport differences, we revealed the vertical distribution and trends of aerosol optical properties in China using 15 years of Cloud‐Aerosol Lidar with Orthogonal Polarization data. The Hybrid Single‐Particle Lagrangian Integrated Trajectory model was used to analyze the transport and trends of different aerosols. We found significant regional and seasonal differences in the vertical distributions of aerosols. The changes in the aerosol optical depth and main aerosol types in a given region were also significantly affected by the changes in aerosol transport sources and transport pathways. This study provides comprehensive insight into the vertical distribution and transport characteristics of different types of atmospheric aerosols in the Chinese region over the last 15 years, which is very important to further evaluation of the impact of different aerosol types on the radiative effects and the environment. Key Points: The vertical distribution of aerosol optical properties exhibits notable seasonal and regional differences using 15 years of Cloud‐Aerosol Lidar with Orthogonal Polarization (CALIOP) dataThe trend of total aerosol optical depth (AOD) mainly depends on the joint changes of the highest frequency aerosol and the maximum AOD layer in a vertical profileThe changes of AOD and main aerosol types in a region are also affected by the changes of aerosol transport sources and transport pathways [ABSTRACT FROM AUTHOR]

Many countries have experienced the increase of groundwater depletion rate (GWDR), posing great challenges to the environment and society. Given the slow variation of groundwater, long‐term estimation of GWDR at high‐resolution is critical for sustainable managements of regional water resources and risks of hydrological extremes in a changing climate. However, limited in‐situ and satellite observations and uncertainties from hydrological model simulations prohibit reliable estimation of the long‐term trend and inter‐annual variation of GWDR. Using survey‐based water withdrawal and water availability datasets, this study provided a spatially distributed estimation of annual GWDR over China at the 0.25° × 0.25° grid scale for the period 1965–2016 using a flux‐based approach. The estimated GWDR has higher spatial resolution and longer temporal coverage than previous products. With the newly compiled data, we found that groundwater over China was depleted at an average rate of 20.4 km3 year−1 during 1965–2016, especially in the arid and semi‐arid areas of northern China. The GWDR showed a significant increasing trend during 1965–2016, but such trend slowed down from 0.66 km3 year−1 during 1965–2001 to 0.06 km3 year−1 during 2001–2016, which was mainly attributed to the deceleration in human water withdrawal. Further analysis showed that over 40% of the inter‐annual variability of GWDR could be explained by precipitation variability, and the climate control increased over time. This study suggested a growing control of climate variations on GWDR over China as the human water withdrawal has been decelerating, and a need for climate change adaptation for a sustainable groundwater management. Plain Language Summary: Groundwater serves as an important freshwater source, and is critical for human life and socioeconomic development. Yet unsustainable groundwater abstraction exceeds recharge from rain and rivers, leading to losses of groundwater storage and substantial drops in groundwater level, namely groundwater depletion. Groundwater depletion would result in significant environmental degradation and threaten food security, which has attracted much attention to long‐term estimation of groundwater depletion at high‐resolution. This study provided a spatially distributed estimation of groundwater depletion rate over China and further analyzed its changing patterns. We found that groundwater depletion in China increased continuously during 1965–2016, but this increasing trend slowed down after 2001 due to the deceleration in human water withdrawal. Results also suggested an increasing negative correlation between groundwater depletion rate and precipitation over time, and addressed the nonnegligible impacts of climate extremes on groundwater depletion. The findings have important implications for groundwater sustainability over water‐scare regions, and water managers should take into account both water demand and climate variations when designing and selecting robust adaptation strategies to cope with groundwater depletion under changing environment. Key Points: Groundwater depletion rate (GWDR) in China was estimated by a flux‐based approach at high spatial resolution and long temporal coverageThe increasing trend of GWDR slowed down after 2001 due to the deceleration in human water withdrawalThere was a significant negative correlation between GWDR and precipitation, and the climate control increased over time [ABSTRACT FROM AUTHOR]

We examine whether analyst independence contributes to analysts' monitoring role in deterring accruals earnings management. We first report a negative association between earnings management and the ratio of independent analysts to brokerage analysts covering a firm. Next, through the lens of the promotion of independent sell‐side research institutions by the 2003 Global Research Analyst Settlement, we document a significant decrease in earnings management on firms affected by the Global Settlement's mandate for time‐limited support to back independent research institutions. Additionally, we find that, as the aforementioned support ended, the extent of monitoring effectiveness reverted to a level indistinguishable from that before the Global Settlement. Finally, using closures and mergers of independent research institutions as a quasi‐natural experiment, we provide corroborating evidence consistent with analyst independence leading to more effective monitoring. [ABSTRACT FROM AUTHOR]

Previous studies have shown that Saharan dust can be transported thousands of miles, affecting regional climates, environments, and ecosystems. However, research on the long‐range transport of Saharan dust in Asia remains limited. We systematically investigated the long‐range transportation of Saharan dust over East Asia from 2007 to 2020 using WRF‐Chem model simulations, space‐borne CALIPSO lidar observations, NCEP/NCAR reanalysis data, as well as HYSPLIT trajectory analysis. The results show that one quarter (24.3 ± 6.2%) of dust events in East Asia during 2007–2020 originated from the Sahara Desert. Moreover, long‐range transported Saharan dust over East Asia was usually distributed in the upper troposphere. The average total amount of transported Saharan dust over East Asia between 2010 and 2015 was estimated at 33.05 ± 9.78 Tg/yr. Additionally, Saharan dust could be transported eastward all year and contributed about 35.8% of dust loading in the upper troposphere in Northern China in spring, which is almost the same amount of dust aerosols lifted up from East Asian dust sources. This study provides new sights on the important role of Saharan dust over East Asia, and elucidates the influence of long‐range transported dust on regional climate and the water cycle. Key Points: About one fourth of dust cases in East Asia from 2007 to 2020 originated from the Sahara DesertLong‐range transported Saharan dust over East Asia was usually distributed in the upper troposphere where is >5 km above sea levelOver East Asia, Saharan dust contributes 35.8% of total dust concentration in the upper troposphere in spring [ABSTRACT FROM AUTHOR]

Groundwater use underpins much economic production. The unsustainable use of groundwater threatens environmental flows in surface waters, sustainable development, and future food security. The connection between agricultural trade and groundwater depletion has been recently highlighted, but how groundwater depletion supports the production of industrial and tertiary goods, trade, and consumption remains less well understood. Here, we present the first analysis of groundwater use and depletion embedded in the complete supply chain of China (including primary, secondary, and tertiary products). We use a multiregion input‐output analysis coupled with the high‐resolution groundwater use modeling to track groundwater depletion from production to end consumer. Our modeling results show that groundwater depletion occurred primarily in water scarce North China for agricultural production, but the depleted resource was then incorporated throughout the supply chain and dispersed across Chinese and international consumers. ∼64 billion m3 yr−1 (±1 billion m3 yr−1) groundwater was depleted in China, in which more than a half was from Xinjiang, Hebei, Henan and Heilongjiang Provinces. Approximately 40% of the groundwater depletion can be traced to interprovincial transfer (21 billion m3 yr−1) and export (4.8 billion m3 yr−1). The hot spots for final consumption of groundwater depletion were major cities in both North and South China. Importantly, over 60% of the groundwater depletion was embodied in industrial and tertiary products for final consumption, highlighting the importance of tracing groundwater through the full economy. Groundwater depletion represents a long‐term risk to supply chains, and policy‐makers can use this understanding to sustainably manage groundwater and diversify supply chains. Plain Language Summary: Groundwater is a critical resource that is under increased pressure due to unsustainable exploitation. Groundwater resources underpin both national supply chains and global trade, but how groundwater supports the full supply chain of a nation remains unresolved. This study traces the groundwater depletion incorporated in the complete supply chain (including industrial and tertiary products, not just primary goods) of China through interprovincial transfers and international exports. The results show how groundwater depletion, which is concentrated in North China, is distributed to domestic and international consumers of final goods. International importers receive China's groundwater in the receipt of industrial products. We highlight that groundwater depletion represents a long‐term risk to supply chains. Key Points: Groundwater depletion is traced using a multi‐region input‐output analysis coupled with the high‐resolution groundwater use modelingAbout 21 billion m3 yr−1 groundwater depletion, primarily from water scarce Northern‐China, is virtually transferred domesticallyGroundwater depletion supporting export to the Rest of the World is estimated to be 4.8 billion m3 yr−1 [ABSTRACT FROM AUTHOR]

The outbreak of COVID‐19 has precipitated international lockdown measures to curb disease transmissions. The closure of public activity spaces as well as changes in pandemic workload may disrupt healthcare workers' physical activity and self‐care routines. We sought to examine the association between physical activity levels and mental health burden of healthcare workers during the COVID‐19 lockdown in Singapore. This cross‐sectional study comprised of an multidomain survey that was administered digitally to 707 healthcare workers between 17 May and 18 June 2020. Exercise frequency, duration and intensity of these healthcare workers had reduced significantly during the lockdown compared to pre‐lockdown. 25.3%, 37.2%, and 11.9% had screened positive for moderate‐to‐extremely‐severe depression, anxiety and stress respectively. Reductions in exercise duration was a significant risk factor for mild stress and moderate‐to‐severe depression while increase in exercise frequency was found to be a protective factor against depressed mood. Our study revealed that a short‐term reduction in physical activity levels during lockdown was associated with poorer psychological outcomes. Given the protection that exercise confers on depression, physical activity should be promoted at the workplace and at home to support healthcare workers to cope through this protracted health crisis. [ABSTRACT FROM AUTHOR]

The assessment of atmospheric aerosol radiative effects in the Tibetan Plateau (TP) suffers from large uncertainties due to limited understanding of aerosol physicochemical properties. To quantify aerosol optical properties, size distributions, and chemical compositions in the western TP, an intensive field campaign was carried out at Shiquanhe National Reference Climatological Station from July 8 to August 2, 2019. Unexpected low single scattering albedo (SSA) at 870 nm was found for the fine aerosols with an average value of 0.73 ± 0.18. SSA was even lower than 0.60 in the morning when fine aerosols peaked, indicating high absorption of the fine aerosols induced by anthropogenic activities. Coarse mode aerosols accounted for 70.58% ± 14.98% of the total volume concentration and mineral dust was the most abundant species in total suspended particles with a mass fraction of 48.7%. Fine mode aerosol concentrations showed little dependence on wind speed while coarse mode aerosols and metallic element concentrations exhibited strong positive correlations with wind speed, indicating the importance of wind‐blown dust particles. The present study for the first time quantified key aerosol parameters in the western TP and unexpected high absorption of atmospheric aerosols were found over the site in summer. Our results suggest the need to carefully consider the radiative effects caused by aerosol absorption in the TP region. Key Points: The fine mode aerosols exhibited strong absorption in summer in the western Tibetan Plateau (TP)The absorption of atmospheric aerosols in summer in the western TP might be significantly underestimated at presentAnthropogenic activities had a large impact on the aerosol concentrations and properties in summer in the western TP [ABSTRACT FROM AUTHOR]

Dust aerosol can affect the atmospheric thermal structure and exert great melting potential on snow and ice sheets. In this study, the decadal climatology of dust‐forced radiative heating (DRH) in the atmosphere over Tibetan Plateau and its surroundings (TPS) was investigated using the Santa Barbara DISORT Atmospheric Radiative Transfer (SBDART) model along with the CALIPSO satellite observations from 2007 to 2016. After screening out other aerosols, the vertical distribution of dust aerosol was examined to accurately assess the DRH. The net DRH showed a significant warm effect mainly by dust loading, which covers from the center of dust sources to their adjacent transport regions. The maximum value of the DRH appeared at the near‐surface, while the DRH decreased with an increase in height. The climatic average DRH at the near‐surface reached 16.8 K/month at the Taklimakan Desert (TD) and 10.8 K/month at the Gangetic Plain in spring, 13.7 K/month at the Indus Plain in summer, which is 3–3.6 times warmer than the column‐averaged DRHs. This study also found the most significant influence of dust events on the Qaidam Basin in the TPS, in which the near‐surface DRH was 4.7 K/month during spring. It is also noteworthy that the intermonth and interannual variations of the DRH highlighted the significant warming effect of dust aerosols on the atmospheric thermal structure, especially at the near‐surface. In addition, we need to pay more attention to changes in snow‐related processes influenced by absorbing aerosols and the light‐absorbing impurities deposited in snow over the TPS. Key Points: Dust‐forced radiative heating (DRH) has a significant warming effect with the center from dust sources to adjacent transport regionsThe near‐surface DRHs over the Tibetan Plateau and its surroundings (TPS) are 3–3.6 times larger than the column‐averaged valueDust aerosols over the TPS may have the potential to exert more snow melting driven by the remarkable near‐surface warming effect [ABSTRACT FROM AUTHOR]

In this study, we examine the spatial and temporal characteristics of water stress in China for the historical (1971–2010) and the future (2021–2050) periods using a multimodel simulation approach. Three water stress indices (WSIs), that is, the ratios of water withdrawals to locally generated runoff (WSIR), to natural streamflow (WSIQ), and to natural streamflow minus upstream consumptive water withdrawals (WSIC), are used for the assessment. At the basin level, WSIR estimates generally match the reported data and indicate severe water stress in most northern basins. At the grid cell level, the WSIs show distinct spatial patterns of water stress wherein WSIR (WSIQ) estimates higher (lower) water stress compared to WSIC. Based on the WSIC estimates, 368 million people (nearly one third of the total population) are affected by severe water stress annually during the historical period, while WSIR and WSIQ suggest 595 and 340 million, respectively. Future projections of WSIC indicate that more than 600 million people (43% of the total) might be affected by severe water stress, and half of China's land area would be exposed to stress. The found aggravating water stress conditions could be partly attributed to the elevated future water withdrawals. This study emphasizes the necessity of considering explicit upstream and downstream relations with respect to both water availability and water use in water stress assessment and calls for more attention to increasing levels of water stress in China in the coming decades. Plain Language Summary: Severe water stress in China has been widely reported, but its time evolution and spatial patterns are rarely assessed. We examine the spatial and temporal change patterns of water stress in China by using multimodel simulations and three different water stress indices (WSIs). Results suggest that different WSIs imply distinct spatial patterns of water stress over China. The WSIs indicate that water stress conditions in northern China are quite distinct from that in southern China. During the past decades (1971–2010), severe water stress is found in northern areas while little is found in southern areas. In the future (2021–2050), however, water‐stressed areas might expand in southern China and water stress levels might aggravate in urban areas, putting considerably more people exposed to severe water stress. This assessment provides useful information for regional water planning/management within the context of future climate change and socioeconomic development in China. Key Points: Water stress estimates can be much different with the consideration of upstream water withdrawal and consumptionSevere water stress conditions are found in northern China in the pastWater‐stressed areas significantly expand over southern China in the future [ABSTRACT FROM AUTHOR]

The interaction between surface water and groundwater is an important aspect of hydrological processes. Despite its importance, groundwater is not well represented in many land surface models. In this study, a groundwater module with consideration of surface water and groundwater dynamic interactions is incorporated into the distributed biosphere hydrological (DBH) model in the upstream of the Yellow River basin, China. Two numerical experiments are conducted using the DBH model: one with groundwater module active, namely, DBH_GW and the other without, namely, DBH_NGW. Simulations by two experiments are compared with observed river discharge and terrestrial water storage (TWS) variation from the Gravity Recovery and Climate Experiment (GRACE). The results show that river discharge during the low flow season that is underestimated in the DBH_NGW has been improved by incorporating the groundwater scheme. As for the TWS, simulation in DBH_GW shows better agreement with GRACE data in terms of interannual and intraseasonal variations and annual changing trend. Furthermore, compared with DBH_GW, TWS simulated in DBH_NGW shows smaller decreases during autumn and smaller increases in spring. These results suggest that consideration of groundwater dynamics enables a more reasonable representation of TWS change by increasing TWS amplitudes and signals and as a consequence, improves river discharge simulation in the low flow seasons when groundwater is a major component in runoff. Additionally, incorporation of groundwater module also leads to wetter soil moisture and higher evapotranspiration, especially in the wet seasons. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Although the Rotterdam 2003 polycystic ovarian syndrome (PCOS) diagnostic criteria is widely used, the need to consider multiple variables makes it unwieldy in clinical practice. We propose a simplified PCOS criteria wherein diagnosis is made if two of the following three items were present: (i) oligomenorrhoea, (ii) anti‐mullerian hormone (AMH) above threshold and/or (iii) hyperandrogenism defined as either testosterone above threshold and/or the presence of hirsutism. Design setting and participants: This prospective cross‐sectional study consists of healthy women (n = 157) recruited at an annual hospital health screen for staff and volunteers from the university community, and a patient cohort (n = 174) comprising women referred for suspected PCOS. Main outcome measures: We used the healthy cohort to establish threshold values for serum testosterone, antral follicle counts (AFC), ovarian volume (OV) and AMH. Women from the patient cohort, classified as PCOS by simplified PCOS criteria, AMH alone and Rotterdam 2003, were compared with respect to prevalence of oligomenorrhoea, hyperandrogenism and metabolic indices. Results: In healthy women, testosterone ≥1.89 nmol/L, AFC ≥22 follicles and OV ≥8.44 mL, best predicted oligomenorrhoea and were used as threshold values for PCOS criteria. An AMH level ≥37.0 pmol/L best predicted polycystic ovarian morphology. AMH alone as a single biomarker demonstrated poor specificity (58.9%) for PCOS compared to Rotterdam 2003. In contrast, there was a 94% overlap in women selected as PCOS by the simplified PCOS criteria and Rotterdam 2003. The population characteristics of these two groups of PCOS women showed no significant mean differences in androgenic, ovarian, AMH and metabolic (BMI, HOMA‐IR) variables. Conclusions: Our data recommend the simplified PCOS criteria with population‐specific thresholds for diagnosis of PCOS. Its ability to replace ovarian ultrasound biometry with the highly correlated variable AMH, and use of testosterone as a single marker for hyperandrogenaemia alongside the key symptoms of oligomenorrhoea and hirsutism confers significant clinical potential for the diagnosis of PCOS. [ABSTRACT FROM AUTHOR]

Objective Although menstrual cycle length is one of the main concerns of women and may have important health consequences, little is known about its predictors. The aim of this study was to identify predictors of menstrual cycle length variability in healthy women. Design Prospective cross-sectional study. Patients Two hundred healthy women aged 21-45. Measurements A questionnaire was administered to determine lifestyle factors. Ovarian parameters, metabolic parameters, pituitary hormones, sex steroids and antimüllerian hormone ( AMH) were measured. Results Women with long (≥35 days) and normal (25-34 days) menstrual cycles had >5-fold and >2-fold higher serum AMH levels, respectively, compared to those with short cycles (<25 days). Menstrual cycle length was associated with age but not lifestyle factors. Only one factor group ( AMH, antral follicle count [ AFC], ovarian volume, testosterone and LH) was significantly associated with menstrual cycle length. Within this factor group, only the ovarian parameters ( AMH, AFC, ovarian volume) predicted menstrual cycle length. Each SD increase in AMH (32·9 pmol/l) and ovarian volume (2·29 cm3) was associated with 2·80-fold (95% CI: 1·67-4·69) and 1·62-fold (95% CI: 1·08-2·43) increased risks, respectively, for longer menstrual cycles. Conclusions AMH, AFC and ovarian volume are positively associated with menstrual cycle length in healthy women. Our identification of AMH as an independent predictor of menstrual cycle length puts forth a new notion of utilizing menstrual cycle length to predict possible AMH-dependent/-associated outcomes. In addition, this novel relationship may facilitate the interpretation of AMH levels and its clinico-pathological significance across different centres. [ABSTRACT FROM AUTHOR]

Objective To assess the efficacy of uterine artery embolization (UAE) combined with dilation and curettage (D&C) within 24 hours for the treatment of a cesarean scar pregnancy (CSP), compared with methotrexate and D&C. Methods A retrospective cohort study of 119 women with CSP was conducted at two tertiary hospitals in Guangzhou and Shenzhen, China, during 2009–2012. Twenty-six women received systemic methotrexate followed by D&C, and 93 women were treated with UAE followed by D&C within 24 hours. Results Mean blood loss was 261.0 ± 357.4 mL in the methotrexate group versus 14.1 ± 40.6 mL in the UAE group ( P < 0.001). The time to resolution of the level of β-human chorionic gonadotropin was 40.5 ± 17.2 days versus 15.4 ± 7.7 days ( P < 0.001), respectively. The duration of hospitalization was 14.6 ± 9.2 days versus 6.2 ± 3.7 days ( P < 0.001), respectively. An additional intervention was needed in 9 (35%) women in the methotrexate group and in 5 (5%) in the UAE group ( P < 0.001). Conclusion UAE combined with D&C within 24 hours was an effective uterine preservation treatment for CSP, and was associated with less blood loss and a shorter hospital stay than administration of methotrexate followed by D&C. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between preconception maternal retinal arteriolar calibre and fetal growth., Design, Setting and Population: A hospital-based, prospective preconception cohort including 369 women with a singleton live birth., Methods: We collected detailed information on sociodemographic status, pregnancy history and lifestyle, and performed retinal imaging at the preconception visit., Main Outcome Measures: We retrieved medical records documenting fetal growth biometrics (e.g., abdominal circumference [AC], head circumference [HC], femur length [FL]) at 11-13, 18-21, 24-28, and 32-34 weeks throughout pregnancy. We then computed the z scores for all fetal growth biometrics from 14 weeks of gestation where data were available, referencing the INTERGROWTH-21st fetal growth chart. We used a linear mixed model to estimate the association between maternal preconception retinal arteriolar calibre and fetal growth biometrics z scores throughout pregnancy, with random intercept accounting for repeated measures within individuals. We then performed a multivariable linear regression of maternal preconception retinal arteriolar calibre and z score changes for all fetal growth biometrics between 24-28 weeks and 32-34 weeks of gestation, after full adjustment., Results: Maternal preconception generalised retinal arteriolar narrowing was consistently associated with a reduction in fetal AC z scores (-0.34; 95% CI -0.66 to -0.03) throughout pregnancy. In addition, women with preconception generalised retinal arteriolar narrowing tended to have significantly reduced z score changes in AC (-0.41; 95% CI -0.90 to -0.001) and fetal FL (-0.55; 95% CI -1.00 to -0.10) between 24-28 weeks and 32-34 weeks of gestation, respectively., Conclusions: Our findings suggest that women with narrower preconception retinal arterioles had smaller fetuses, evidenced by reductions in AC and FL z score throughout pregnancy., (© 2023 National University of Singapore. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)