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Background: During cardiopulmonary resuscitation (CPR), end-tidal carbon dioxide (EtCO2) is primarily determined by pulmonary blood flow, thereby reflecting the blood flow generated by CPR. We aimed to develop an EtCO2 trajectory-based prediction model for prognostication at specific time points during CPR in patients with out-of-hospital cardiac arrest (OHCA).Methods: We screened patients receiving CPR between 2015–2021 from a prospectively collected database of a tertiary-care medical center. The primary outcome was survival to hospital discharge. We used group-based trajectory modeling to identify the EtCO2 trajectories. Multivariable logistic regression analysis was used for model development and internally validated using bootstrapping. We assessed performance of the model using the area under the receiver operating characteristic curve (AUC).Results: The primary analysis included 542 patients with a median age of 68.0 years. Three distinct EtCO2 trajectories were identified in patients resuscitated for 20 minutes (min): low (average EtCO2 10.0 millimeters of mercury [mm Hg]; intermediate (average EtCO2 26.5 mm Hg); and high (average EtCO2: 51.5 mm Hg). Twenty-min EtCO2 trajectory was fitted as an ordinal variable (low, intermediate, and high) and positively associated with survival (odds ratio 2.25, 95% confidence interval [CI] 1.07–4.74). When the 20-min EtCO2 trajectory was combined with other variables, including arrest location and arrest rhythms, the AUC of the 20-min prediction model for survival was 0.89 (95% CI 0.86–0.92). All predictors in the 20-min model remained statistically significant after bootstrapping.Conclusion: Time-specific EtCO2 trajectory was a significant predictor of OHCA outcomes, which could be combined with other baseline variables for intra-arrest prognostication. For this purpose, the 20-min survival model achieved excellent discriminative performance in predicting survival to hospital discharge.

Joint absence in people with upper-limb-difference leads to compensatory motions. Such compensation has long been a topic of study, but typically only for a single object/user layout, which is unlikely to spatially generalize. We seek to understand how motion varies over a planar workspace for different target orientations and wrist mobility conditions. We therefore present a study that records arm and torso pose during grasping of 49 equally spaced cylindrical targets. Furthermore, we seek to validate the research practice of using wrist-immobilizing bypass sockets on able-bodied participants to simulate prostheses without wrists. Participants were 2 transradial amputees and 7 able-bodied individuals who conducted the study with and without wrist braces, generating 2450 trajectories. Heat-maps illustrate variation over the workspace in Mean Joint Angle, Range of Joint Motion and Distance Travelled by Body Segment. Results indicate that greater wrist restriction primarily exacerbated shoulder internal rotation and elbow flexion, not the trunk. We observed that bypass sockets do not fully simulate amputee behavior. Furthermore, amputee reaching with their intact limb is different to the reaching motion of normative participants, implying that transradial limb-difference affects both sides of the body. Differences in participant behavior were also observed between horizontal and vertical target orientations.

A key challenge of implementing advance care planning lies in the fact that decisions made in advance require patients and their family members to imagine what their clinical picture will look like rather than knowing or experiencing the clinical circumstances as they unfold. Even more important is the acknowledgment of the unpredictability of a given clinical course. This type of situation requires adaptiveness and flexibility in decision-making that frequently occurs in the moment(s) triggered by changes in health state(s). We describe an alternative frameshifting approach called Adaptive Care Planning (AdaptCP), which features an evolving communication between physicians and patients/families with ongoing incorporation of the patients/familys perspective. This process continues iteratively until each decision can be reached in a way that is both harmonious with the patients/familys perspective and is consistent with medical treatment options that are actionable for the healthcare team. We include a table of tools drawn from the literature that can help clinicians when implementing AdaptCP.

ABSTRACT Objectives Methods Results Conclusions Understanding the patterns and implications of coexisting musculoskeletal conditions is crucial for developing effective management strategies and improving care for older adults. This study aimed to examine the associations between musculoskeletal multimorbidity burden and trajectory and holistic well‐being among middle‐aged and older adults.This prospective study employed data from nine consecutive waves of the English Longitudinal Study of Aging (ELSA), spanning 2002–2018. We used latent class trajectory models (LCTM) to identify groups based on changes in musculoskeletal multimorbidity status. Subsequently, we employed linear mixed models to investigate the associations between musculoskeletal disease burden, trajectory groups, and seven dimensions of holistic well‐being: Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), depression, memory, loneliness, social interactions, and life satisfaction.In total, 5272 participants (mean age: 71.9 years; SD: 8.9) were included in the final analysis. Four distinct trajectories were identified: a low‐burden group (48.37%), an emerging group (14.76%), a moderate‐burden group (26.00%), and a persistent burden group (10.87%). After adjustment, the findings demonstrate that the musculoskeletal disorder burden significantly impacts ADLs, depression, memory, social interactions, and life satisfaction in middle‐aged and older adults, with minor effects on IADLs and loneliness. Moreover, with the escalation of the burden, its impact significantly intensifies (p for trend is < 0.001). Compared with the low‐burden group, participants in both the moderate and persistent burden groups exhibited significantly lower capabilities in ADLs, poorer memory, increased social interactions, and lower life satisfaction. The emerging group displayed a similar trend, though without statistically significant results.Our study suggests that the extent and persistence of musculoskeletal disease burden can significantly affect holistic well‐being among middle‐aged and older individuals. [ABSTRACT FROM AUTHOR]

Background: This study aims to examine the association of depressive trajectories with disability‐free‐survival (DFS). Methods: This prospective cohort study used data from the China Health and Retirement Longitudinal Study, 2011–2015. Depressive symptoms were assessed using the Centre for Epidemiology Studies Depression Scale‐10. Disability was assessed using activities of daily living (ADLs) and instrumental ADLs. Trajectories of depressive symptoms were identified and classified by latent mixture modelling. Logistic regression models were used to examine the association between depressive trajectories and DFS. Results: A total of 8373 participants aged 45 years and older were included. We identified four distinct trajectories of depressive symptoms: 'no depressive symptoms', 'decreasing depressive symptoms', 'increasing depressive symptoms', and 'persistent depressive symptoms'. Compared to participants in the no depressive symptom trajectory, those in the decreasing depressive symptoms, increasing depressive symptoms and persistent depressive symptoms trajectories had an increased risk of disability or mortality, with multiple‐adjusted hazard ratios (95% confidence intervals) of 1.75 (1.45–2.12), 2.05 (1.77–2.38) and 3.50 (2.77–4.42). Conclusion: Our study shows that among middle‐aged and older Chinese adults, individuals with a trajectory of depressive symptoms are at increased risk of disability or mortality. Our findings underscore the importance of early prevention, identification and intervention of depression in clinical care to promote healthy ageing. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine childhood neighbourhood quality, peer relationships, and trajectories of depressive symptoms among middle-aged and older Chinese adults. Methods: The data came from the longitudinal dataset from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018). Depressive symptoms were measured repeatedly using the ten-item Centre for Epidemiologic Studies Depression Scale (CES-D-10). Latent growth modelling was used to capture the trajectory of depressive symptoms by childhood neighbourhood quality, and peer relationships. Results: The mean level of depressive symptoms increased gradually in the follow-up period. Poorer childhood neighbourhood quality, and peer relationships were significantly associated with higher levels of depression in later life (β = 0.18 and β = 0.28 for aged 45–59, p < 0.001; β = 0.16 and β = 0.33 for aged 60 and over, p < 0.001) at baseline and a faster increase in depressive symptoms with age for childhood neighbourhood quality (β = 0.03, p < 0.01 for aged 45–59; β = 0.05, p < 0.01 for aged 60 and over). For males and females, poorer childhood neighbourhood quality, and peer relationships predicted higher levels of depression at baseline (β = 0.17 and β = 0.36 for males, p < 0.001; β = 0.16 and β = 0.27 for females, p < 0.001), and only neighbourhood quality was associated with a higher rate of change in depression during follow-up (β = 0.03, and β = 0.04, p < 0.05, respectively). Conclusion: Poorer childhood neighbourhood quality was associated with the slope of change in depressive symptoms. Efforts towards improving childhood living conditions may help to prevent the detrimental health effects of such early life disadvantages. [ABSTRACT FROM AUTHOR]

Accurate detection plays a critical role in improving the safety situation of vulnerable road users. This study extends infrastructure-based LiDAR application to all three major vulnerable road user groups including pedestrians, cyclists, and wheelchair users. Two critical problems for accurate detection of small-sized road users are scanning angle variability and feature fluctuation. To address these issues, a feature-based classification method combined with prior LiDAR trajectory information is developed. Effective dimension-related features are proposed and five classifiers including artificial neural network (ANN), random forest (RF), adaptive boosting (AdaBoost), random under-sampling boosting (RUSBoost), and long short-term memory (LSTM) are tested with a novel feature engineering process. A total of seven features are selected from the point cloud of clusters for vehicle/pedestrian/cyclist/wheelchair classification. By updating these significant features based on prior information of the entire trajectory, the performance of road user classification (imbalanced datasets) has been significantly improved. Experimental study is conducted to examine the recall rate, F1-score, and AUC of vehicles, pedestrians, cyclists, and wheelchairs before and after integration with prior trajectory information. The result shows the trained AdaBoost, RUSBoost, and LSTM classifiers with prior trajectory information can achieve recall/F1-score/AUC: (1) Low traffic volumes – vehicles (100%/99.96%/99.96%), pedestrians (99.96%/99.96%/99.97%), cyclists (99.74%/99.45%/99.67%), and wheelchairs (99.22%/99.68%/99.01%) and (2) Moderate traffic volumes – vehicles (99.39%/99.44%/99.69%), pedestrians (98.33%/97.99%/98.64%), and cyclists (95.41%/94.29%/94.40%), using 32-laser LiDAR sensors (10 Hz). [ABSTRACT FROM AUTHOR]

The Developing Indigenous Early Career Researchers Project is a three-year longitudinal study funded by the Australian Research Council that ran from January 2020 to December 2022. Its main focus was to investigate the experiences and perspectives of Indigenous Early Career Researchers working in universities across Australia. This article presents four main attributes identified by Indigenous Early Career Researchers as necessary to creating culturally safe spaces in Australian universities. These attributes include, safe to: (a) be Indigenous; (b) seek advice and make mistakes; (c) speak openly; and (d) trust. The successful implementation of these attributes requires institutional support and commitment in the form of relevant higher education policies and practices. Importantly, an overarching perspective of this article is that effective implementation of culturally safe spaces for Indigenous Early Career Researchers requires a significant shift in institutional discourse from the inclusion of Indigenous Peoples and Knowledges to recognising Indigenous Peoples as sovereign. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between changes in haemoglobin A1c (HbA1c) and the concurrent incidence of cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM) patients. Method: We conducted a retrospective cohort study among T2DM patients with HbA1c measurement after T2DM diagnosis between August 2009 and September 2010. The patients were classified into six subgroups based on baseline HbA1c (<7%; 7%–7.9%; ≥8%) and age (<65; ≥65 years), and then clustered into classes by HbA1c trajectory and CVD incidence over the 12‐year follow‐up period using joint latent class mixture models. We explored the HbA1c trajectories and CVD incidences in each latent class. Multinomial logistic regression was used to compare the baseline characteristics among different latent classes. Results: A total of 128 843 T2DM patients were included with a median follow‐up period of 11.7 years. Ten latent classes were identified in patients with baseline HbA1c ≥ 8% and age <65 years, while seven classes were identified in the other five groups. Among all the identified latent classes, patients with fluctuating HbA1c trajectories, characterized by alternating periods of increase and decrease, had higher CVD incidences. Male patients, and patients with higher baseline HbA1c and use of antidiabetic drugs were more likely to have a fluctuating HbA1c trajectory. More specifically, patients aged < 65 years with younger age or a smoking habit, and patients aged ≥ 65 years with a longer duration of T2DM were more likely to have a fluctuating HbA1c trajectory. Conclusion: We found that T2DM patients with fluctuating HbA1c trajectories could have a higher CVD risk. Different trajectory‐associated characteristics in age subgroups highlight the need for individualized management of T2DM patients. [ABSTRACT FROM AUTHOR]

Backgrounds: Cancer antigen 125 (CA125) is widely used for screening ovarian cancer (OC), yet its effectiveness remains debated. Potential factors may include ineffective cut-off value for CA125 in screening, as well as a lack of consideration for CA125 trajectories and trajectory-specific progression. Methods: Based on data from multiple rounds of CA125 tests and transvaginal ultrasound (TVU) examinations conducted on 28,456 women in the PLCO Trial, time-dependent receiver-operating-characteristic curves (ROCs) and area-under-the-curves (tdAUCs) analyses were employed to identify the optimal CA125 cut-off values for OC screening. Participants were categorized into four CA125 trajectories: stable negative CA125 (CA125SN), loss of positive CA125 (CA125LP), stable positive CA125 (CA125SP), and gain of positive CA125 (CA125GP). The associations between different CA125 trajectories, trajectory-specific progression indicators, and OC risk were explored. The effectiveness of risk-stratified CA125 screening, incorporating CA125 trajectories, trajectory-specific progression, and TVU, was evaluated using hazard ratio and 95% confidence intervals [HR (95%CIs)], with adjustments for potential confounders. Results: After a median follow-up of 14.8 years for OC incidence and 23.8 years for OC mortality, 250 OC cases and 218 OC deaths were identified. The tdAUC for 10-year OC incidence with CA125 was 0.663, with an optimal cut-off value of 13.00 U/ml. Trajectory analyses showed that both CA125SP and CA125GP were significantly associated with increased risks of OC incidence [HRs (95%CIs): 2.00(1.47–2.73) and 3.06(2.25–4.16)] and mortality [HRs (95%CIs):1.58(1.13–2.21) and 2.60(1.87–3.62)] compared to CA125SN. Trajectory-specific progression analyses identified relative velocity as the optimal progression indicators for both CA125SP and CA125GP (tdAUCs: 0.712 and 0.767), with optimal cut-off values of 9% and 32% per year, respectively. Positive progression was associated with significantly increased risks of OC incidence [HRs (95%CI): 7.26(4.00-13.17) and 3.83(1.96–7.51) CA125GP and CA125SP] and mortality [HRs (95%CI): 8.03(4.15–15.56) and 6.04(2.78–13.14)] compared to negative progression. Optimized risk-stratified CA125 screening, which integrated CA125 trajectories, trajectory-specific progression, and TVU, reduced missed OC by 3.6% and improved accuracy compared to traditional screening methods. Conclusions: Incorporating CA125 trajectories and trajectory-specific progression into screening protocols enhances the identification of the population at high-risk of OC. An optimized screening strategy, which includes these factors along with TVU, is recommended to improve the effectiveness of OC screening. [ABSTRACT FROM AUTHOR]

Background: Previous research has indicated that engagement in social activities has proven advantageous for diminishing the likelihood of cognitive decline. However, no study has examined whether such cognitive benefits were to a similar extent for the young-old, the old-old, and the oldest-old groups. The purpose of this research was to determine whether aging would have an impact on the changes in cognitive function that would occur in older adults with varying degrees of social involvement. Methods: The sample for this study comprised 4,481 older adults who participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) during the waves spanning from 2008 to 2018. At baseline, participants were classified into the young-old (60-69 years; Mage = 66.66; SD = 1.87), the old-old (70-79 years; Mage = 74.21; SD = 2.82), and the oldest-old (80 years or older; Mage = 86.46; SD = 5.71) groups. Results: The level of cognitive function decreased as participants aged. Importantly, compared to those lacking social activities, individuals who were got involved in social engagement at baseline had slower rates of cognitive decline over time. Furthermore, compared with the young-old group and the old-old group, the impact of social activity engagement on slowing cognitive decline was more salient for the oldest-old group. Conclusion: Active engagement in social activities can slow age-related cognitive decline, particularly for the oldest-old group. To preserve cognitive function with aging, attention and resources should be allocated to encourage social activity engagement. [ABSTRACT FROM AUTHOR]

Objectives: To examine the correlation between healthy lifestyle patterns, their change trajectories, and the risk of multimorbidity in adults. Methods: Based on two representative national cohorts, the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) including adults aged 50 years and over. We employed Cox regression, lifestyle change trajectories, and restricted mean survival times to explore the relationship between lifestyle (assessed by SCORE2, LE'8, and HLS scores) and multimorbidity. We also conducted mediation analysis to investigate the underlying mechanisms. Results: A healthy lifestyle (higher LE'8, higher HLS, or lower SCORE2) can reduce the risk of multimorbidity. 2-10% lower multimorbidity risk per one-point increase in LE'8 and HLS. The hazard ratio of multimorbidity for improvements in unhealthy lifestyles or deterioration in healthy lifestyles compared to always healthy lifestyles ranged from 1.598 to 5.602. Besides, for LE'8 and HLS, participants with higher scores had a slower decrease in survival probability in ELSA. Triglyceride, C-reaction protein, fibrinogen, and cystatin C partly mediate the association between lifestyle and multimorbidity. Conclusions: Keeping a healthy lifestyle over time can help reduce the risk of multimorbidity. Key messages: 1. The first study to investigate the link of healthy lifestyle patterns and their change trajectories to multimorbidity. 2. Adherence to a healthy lifestyle has a greater disease-preventive effect in the long term than in the near term. 3. Deterioration in healthy lifestyle is associated with a higher risk of multimorbidity. Key points: Question Is lifestyle and its trajectory related to multimorbidity? Findings We found that adherence to healthy lifestyles (higher LE'8 or HLS, lower SCORE2) was associated with a lower risk of multimorbidity. Deterioration in healthy lifestyle is associated with a higher risk of multimorbidity compared to a consistently healthy lifestyle. In addition, adherence to a healthy lifestyle has a greater disease-preventive effect in the long term than in the near term. Meaning Our research findings suggested that a healthy lifestyle can help reduce the risk of developing multimorbidity. The more persistent, the better the quality of life. [ABSTRACT FROM AUTHOR]

Aims Materials and Methods Results Conclusions This study aims to determine whether postpartum body mass index (BMI) trajectories and its time in target range (TTR) are associated with long‐term type 2 diabetes risk in women with a history of gestational diabetes mellitus (GDM).The present study included 1057 women with a history of GDM who participated in the Tianjin Gestational Diabetes Mellitus Prevention Program (TGDMPP). Oral glucose tolerance tests or physician‐diagnosed information were used to diagnose type 2 diabetes after a median follow‐up period of 8.47 years. Latent class modelling was applied to identify trajectories of BMI after delivery. TTR was defined as the proportion of time that BMI was within the standard range (18.5 ≤ BMI < 24.0 kg/m2). The associations of BMI trajectories and TTR with type 2 diabetes risk were analysed using multivariable Cox modelling.Five distinct trajectories of postpartum BMI were identified. Compared with low‐stable class, the multivariable‐adjusted hazard ratios of type 2 diabetes were 2.02 (95% confidence interval 0.99–4.10) for median‐stable class, 3.01 (1.17–7.73) for high‐stable class, 2.15 (0.63–7.38) for U‐shape class and 7.15 (2.08–24.5) for inverse U‐shape class (p for trend = 0.012), respectively. Multivariable‐adjusted hazard ratios of type 2 diabetes associated with postpartum BMI TTR of 100%, >43.4%–<100%, >0%–≤43.4% and 0% were 1.00, 1.84 (0.72–4.73), 2.75 (1.23–6.15) and 2.31 (1.05–5.08) (p for trend = 0.039), respectively.Postpartum BMI trajectories of high‐stable and inverse U‐shape class as well as lower TTR were associated with an increased risk of type 2 diabetes among women with a history of GDM. Reducing BMI to a normal range in the early postpartum period and maintaining stable over time could attenuate the development of long‐term type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemia is one of the most common comorbidities in patients with acute ischemic stroke (AIS). This study aimed to assess the impact of short-term longitudinal blood glucose level change trajectories on the 30-day mortality risk in patients with AIS. Methods: Data for AIS patients were obtained from the 2001–2019 Medical Information Mart for Intensive Care (MIMIC) database. The latent growth mixture modeling (LGMM) was utilized to classify a patient's blood glucose level trajectory within 24 h of admission. Cox regression analyses were applied to examine the relationship between blood glucose levels at admission and blood glucose level trajectories and the risk of 30-day mortality in patients with AIS. Results: A total of 2,432 patients with AIS were included in this retrospective cohort study, with 30-day mortality occurring in 574 (23.60%) patients. The median glucose levels of all patients were 136.00 (110.00, 178.00) mg/dL. Four blood glucose level trajectories were identified: low level-stable trend (type 1), moderate level-stable trend (type 2), high level-decreasing-increasing trend (type 3), and moderate level-increasing-decreasing trend (type 4). Type 2 blood glucose level trajectory was associated with an increased risk of 30-day mortality compared with type 1 blood glucose level trajectory [hazard ratio (HR) = 1.28, 95% confidence interval (CI): 1.03–1.59), but there were no significant associations between type 3 (HR = 1.16, 95%CI: 0.77–1.74) and type 4 (HR = 1.44, 95%CI: 0.84–2.45) trajectories and 30-day mortality risk. Subgroup analysis demonstrated that the association between type 2 trajectory and 30-day mortality risk was observed in patients aged ≥ 65 years (HR = 1.37, 95%CI: 1.05–1.79), female (HR = 1.42, 95%CI: 1.05–1.94), with (HR = 1.44, 95%CI: 1.02–2.02) or without (HR = 1.42, 95%CI: 1.01–1.99) diabetes, and not using insulin (HR = 2.80, 95%CI: 1.43–5.49). Conclusion: AIS patients with consistently high blood glucose levels within 24 h of admission increased the risk of 30-day mortality. [ABSTRACT FROM AUTHOR]

Background: Social engagement is closely related to well-being among older adults. However, studies on the changing trajectory and influencing factors (especially time-varying factors) of social engagement are limited. This study aimed to examine the social engagement trajectory of older Chinese adults and explore its time-fixed and time-varying factors, thus providing evidence for the development of strategies to promote a rational implementation for healthy aging. Methods: This study included 2,195 participants from a subset of four surveys from the Chinese Longitudinal Healthy Longevity Survey conducted from 2008 to 2018 (with the latest survey completed in 2018), with follow-ups conducted approximately every three years. Growth mixture modeling was used to explore the social engagement trajectory of older adults and the effects of time-varying variables. In addition, multinomial logistic regression was employed to analyze the association between time-fixed variables and latent classes. Results: Three distinct trajectories of social engagement among older adults in China were identified: slow declining (n = 204; 9.3%), which meant social engagement score decreased continuously, but social engagement level improved; slow rising (n = 1,039; 47.3%), marked by an increased score of social engagement, but with an depressed engagement level; and middle stabilizing (n = 952; 43.4%), which meant social engagement score and engagement level remained quite stable. A time-fixed analysis indicated that age, marital status, educational level, and annual family income had a significant impact on social engagement (P < 0.05). In contrast, the time-varying analysis showed that a decline in functional ability, insufficient exercise (means no exercise at present), deteriorating self-reported health and quality of life, negative mood, monotonous diet, and reduced community services were closely related to the reduction in social engagement levels (P < 0.05). Conclusion: Three trends were observed at the social engagement level. Older adults with initially high levels of social engagement exhibited a continuous upward trend, whereas those with initially low levels experienced a decline in their social engagement, and those with initially intermediate levels remained quite stable. Considering the primary heterogeneous factors, it is imperative for governments to enhance basic services and prioritize the well-being of older adults. Additionally, families should diligently monitor the emotional well-being of older adults and make appropriate arrangements for meals. [ABSTRACT FROM AUTHOR]

Background: The association between changes in insulin resistance, reflected by the triglyceride-glucose (TyG) index, and mortality remains unclear. This study investigated whether longitudinal trajectories of TyG index changes are associated with all-cause and cardiovascular disease (CVD) mortality. Methods: This retrospective cohort study analyzed data from 233,546 adults aged ≥ 19 years from the Korea National Health Insurance Service-National Sample Cohort. Participants were categorized as having increasing, stable, or decreasing TyG index changes during a 4-year exposure period (2009–2014). Mortality outcomes were assessed during an 8.13-year follow-up period (2015–2021). Cox proportional hazards regression and competing risk analysis were used to evaluate all-cause and CVD mortality. Results: A total of 7918 mortality events, including 651 CVD deaths, were recorded. Compared with the stable group, adjusted hazard ratios for all-cause mortality were 1.09 (95% CI 1.03–1.15) in the increasing group and 1.23 (95% CI 1.01–1.50) for CVD mortality. An increased TyG index was significantly associated with all-cause mortality in individuals aged < 50 years; men; and individuals with obesity, hypertension, diabetes, and/or dyslipidemia. For CVD mortality, significant associations were found in individuals aged 50–69 years, with obesity, with diabetes, or without dyslipidemia. Conclusion: An increasing TyG index from baseline during follow-up was independently associated with higher risks of all-cause and CVD mortality. Serial monitoring of TyG index changes could enhance risk stratification and inform targeted interventions to reduce insulin resistance, and ultimately lower mortality risk. [ABSTRACT FROM AUTHOR]

Suicidal thoughts and behaviors often emerge in a predictable sequence, with suicidal ideation (SI) preceding planning, and planning preceding actions. Few studies, however, have considered the timing and duration of non-suicidal self-injury (NSSI) in these transitions. Accordingly, this study examined: 1) the developmental sequencing of NSSI, SI and suicide attempts, and 2) whether age of onset or duration predict transitions from NSSI to other SITB, and from SI to NSSI. 704 first-year students from a mid-sized Canadian university (Sample 1) and 2095 adults from an online research volunteer panel (Sample 2) completed the Self-Injurious Thoughts and Behaviors Interview self-report, which assessed the presence, age of onset, and recency of SITB. NSSI and SI typically onset before age 15, while suicide planning and attempt usually began at or after age 15. Transition from NSSI to SI was likeliest in the first year after NSSI onset. Transition from NSSI to suicide attempt was likeliest in the second and third year after NSSI onset in Sample 1, and up to four years after NSSI onset in Sample 2. Early (before age 13) and late (after age 16) onsets of NSSI predicted higher odds of transitioning from NSSI to SI or attempt. Transition from SI to NSSI was likeliest in the first two years after SI onset and when SI began before age 13. The first year after NSSI or SI onset are critical for transitions to other SITB. Targeted prevention and monitoring should be considered for people who recently initiated NSSI. • NSSI and suicidal ideation (SI) typically begin within 1–2 years of each other • Transition from NSSI to SI was likeliest in the first year after NSSI onset • Transition risk from NSSI to attempt persisted for 3+ years after NSSI onset • NSSI onset before age 13 or after 16 predicted transitioning to SI or attempt • Onset of SI before age 13 predicted transition to NSSI [ABSTRACT FROM AUTHOR]

Background/Objectives: Co-occurring mental health conditions affect autistic individuals at high rates, impacting their well-being and quality of life. Mental health conditions are often appropriate treatment targets that can improve the lives of autistic individuals. Because of this, there is growing interest in predictors of mental health and behavioral outcomes. Given the rapidly evolving evidence base and growing literature using longitudinal cohorts, it is unclear which predictors of symptoms of anxiety and depression are consistent, and which are not. Additionally, it is difficult to deduce which predictors of mental health symptoms at a given time also predict change over time. This can be partially due to the different statistical approaches that are implemented, including trajectory vs. non-trajectory methodologies. Methods: We conducted a systematic review to evaluate how non-trajectory and trajectory analyses inform our knowledge of how symptoms of anxiety and depression change over time. Additionally, we aimed to identify important predictors of change and later anxiety and depressive symptoms in autistic individuals. Results: There is variability in symptoms of anxiety and depression in autistic individuals. Adaptive skills arose as significant predictors of change and of later symptoms of both anxiety and depression. Peer relationships in school age seem to be particularly important in predicting later symptoms of depression. Conclusions: This review provides evidence that there are different trajectories and different patterns of mental health symptoms over the lifespan, providing further evidence that autism is a developmental condition that changes over time in different ways for different people. Implications and future directions are further discussed. [ABSTRACT FROM AUTHOR]

Aims: Previous studies have shown that higher hemoglobin A1c (HbA1c) levels within the normal range during pregnancy can increase the risk of adverse birth outcomes. However, the effects of the longitudinal HbA1c trajectory during pregnancy on adverse birth outcomes among non-gestational diabetic women are poorly characterized. We aimed to identify HbA1c trajectory during pregnancy among non-gestational diabetic women and to estimate their associations with adverse birth outcomes. Methods: Data was extracted from the Information System of Guangdong Women and Children Hospital, China, from January 2017 to July 2022. This study involved 13,979 women who did not have gestational diabetes mellitus and underwent repeated HbA1c measurements during pregnancy. Latent mixture modeling was used to identify HbA1c trajectory groups. Logistic regression was applied to explore the associations between HbA1c trajectory groups and adverse birth outcomes, including preterm delivery, low birth weight, macrosomia, small for gestational age, and large for gestational age (LGA). Results: Three HbA1c trajectory groups were identified: low-stable (range 4.0% [20 mmol/mol]–4.4% [25 mmol/mol]), moderate-stable (range 4.6% [27 mmol/mol]–5.1% [32 mmol/mol]), and elevated-increasing (range 5.0% [31 mmol/mol]–5.6% [38 mmol/mol]). Compared with the low-stable HbA1c group, the elevated-increasing group had a higher risk of preterm delivery and LGA. The adjusted OR (95% CIs) were 1.67 (1.13, 2.49) and 1.47 (1.01, 2.12) for preterm delivery and LGA, respectively. Conclusions: Among non-gestational diabetic women, the elevated-increasing HbA1c trajectory group was associated with a higher risk of preterm delivery and LGA. This finding emphasizes the importance of maintaining optimal HbA1c levels throughout pregnancy. [ABSTRACT FROM AUTHOR]

While many parameters contribute to swimming start performance, a few have been proven to affect the overall start performance more significantly than others; these include take-off velocity, flight time, entry water distance, time underwater during descent and ascent, and free-swimming velocity. This study aims to analyse the influential trajectory of these key parameters on the overall start performance, particularly focusing on determining the optimal breakout point. Ten national-level swimmers participated in this study, which combined kinematics and statistical analysis to propose a novel start model that can be used to explore the influential trajectory of key parameters on the overall start performance and assess the effect of some training factors for performance improvement. Further, this study investigated the optimal breakout position via a mathematical model. This is the first study to provide a solution to determine this parameter. The solution is verified to be practical through trial data, and the overall start performance is improved by 0.71–3.29%, depending on the swimmer's current level. Therefore, the results can be used as a reference for swimming start training and improvement. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to investigate trajectories of anxiety and depression symptoms among gynaecological cancer (GC) patients having curative-intent radiotherapy (RT) treatment and identify which patient characteristics predict anxiety and depression trajectories. Methods and measures: Latent profile analysis (LPA) was used to identify unique trajectories of anxiety and depression symptoms, spanning prior to the start of RT until 12-month post-RT, among 151 GC patients in the PeNTAGOn randomized control trial. Demographic and clinical characteristics were assessed at baseline, and anxiety and depression symptoms were assessed five times over 12 months. A bias-adjusted 3-step maximum likelihood approach was used to identify demographic and clinical predictors of trajectory profiles. Results: Four latent profiles each were identified for anxiety and depression trajectories. Most patients had minimal to mild levels of anxiety or depression that remained steady or declined over 12 months following treatment. A minority of patients were in profiles that exhibited clinically significant distress; either 'High fluctuating' anxiety or 'Mild-moderate fluctuating' depression. Anxiety and depression profiles were predicted by clinical and demographic factors, such as age, living arrangements, RT type, cancer stage, physical symptom distress and use of support services. Conclusions: Psychological care of patients in the higher distress trajectories is paramount and, importantly, they could be identified prior to treatment based on the factors identified. Review for at least a month post-RT is warranted. [ABSTRACT FROM AUTHOR]

Inconsistent associations between antenatal depression and fetal birth weight were reported previously, and little is known about the dynamic changes and long-term cumulative effect of antenatal depression during pregnancy. Participants were from the Tongji-Huaxi-Shuangliu Birth Cohort. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale in early, middle, and late pregnancy respectively. Trajectories of antenatal depression were assessed using the latent class mixed model. The percentage of days with depression (PDD) and frequency of antenatal depression were measured to assess the cumulative exposure. Multivariable logistic regression models were used to evaluate the associations of antenatal depression with macrosomia and large for gestational age (LGA). We identified four distinct trajectories, including the low stable group (n = 1,327, 27.99 %), the moderate stable group (n = 2,610, 55.05 %), the peak group (n = 407, 8.58 %), and the valley group (n = 397, 8.37 %). Compared with the low stable group, the valley group showed a higher risk of macrosomia (OR, 1.98; 95 % CI, 1.17, 3.38) and LGA (OR, 1.44; 95 % CI, 1.002, 2.09); the peak group showed a higher risk of LGA (OR, 1.52; 95 % CI, 1.07, 2.16), but the association was not significant for macrosomia (OR, 1.47; 95 % CI, 0.85, 2.55). Consistently, cumulative antenatal depression was also positively associated with the risks of macrosomia and LGA. The antenatal depression was self-reported using a screening scale and information bias could not be ruled out. Certain trajectories and cumulative exposure of antenatal depression were associated with higher risks of high birth weight. • Four distinct trajectories (groups) of antenatal depression were identified. • The peak and valley groups showed higher risks of high birth weight among the four groups. • The positive associations were confirmed when cumulative exposure of antenatal depression was assessed. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is the fourth most common cancer and highly prevalent in South Korea. As one of the predictors of gastric cancer, we focused on health utilization patterns and expenditures, as the surrogate variables of health conditions. This nested case-control study aimed to identify the association between health expenditure trajectory and incidence of gastric cancer. Methods: Data from the National Health Insurance Service Senior Cohort of South Korea were used. Individuals diagnosed with gastric cancer (N = 14,873) were matched to a non-diagnosed group (N = 44,619) in a 1:3 ratio using a nested case-control design. A latent class trajectory analysis was performed to identify the patterns of health expenditure among the matched participants. Furthermore, conditional logistic regression analysis was conducted to examine the relationship between healthcare expenditure trajectories and gastric cancer incidence. Results: Seven distinct health expenditure trajectories for five years were identified; consistently lowest (13.8%), rapidly increasing (5.9%), gradually increasing (13.8%), consistently second-highest (21.4%), middle-low (18.8%), gradually decreasing (13.1%), and consistently highest (13.2%). Compared to the middle-low group, individuals in the rapidly increasing [odds ratio (OR) = 2.11, 95% confidence interval (CI); 1.94–2.30], consistently lowest (OR = 1.40, 95% CI; 1.30–1.51), and gradually increasing (OR = 1.26, 95% CI; 1.17–1.35) groups exhibited a higher risk of developing gastric cancer. Conclusions: Our findings suggest that health expenditure trajectories are predictors of gastric cancer. Potential risk groups can be identified by monitoring health expenditures. [ABSTRACT FROM AUTHOR]

This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems). The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4–5, 8–9, 16–17, and 26–27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4–5, 8–9, and 16–17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26–27 years after the birth of the first child. Complete follow-up data were available for 168 mothers. We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning. Maternal and child measures were based on maternal reports only. The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children. • We present maternal depressive symptom trajectories over 27 years (1989–2017) • The maternal symptom trajectories were Very Low, Low Stable and High Stable • Low Stable trajectory predicted the best and High Stable the least optimal outcome • Child's problems predicted mother's problems but not her adaptive functioning [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Conclusions Amyloid β (Aβ), a major biomarker of Alzheimer's disease, leads to tau accumulation, neurodegeneration and cognitive decline. Modelling the trajectory of Aβ accumulation in cognitively unimpaired (CU) individuals is crucial, as treatments targeting Aβ are anticipated. The evolution of Aβ levels was investigated to determine whether it could lead to classification into different groups by studying longitudinal Aβ changes in older CU individuals, and differences between the groups were compared.A total of 297 CU participants were included from the Alzheimer's Disease Neuroimaging Initiative database, and these participants underwent apolipoprotein E (APOE) genotyping, neuropsychological testing, brain magnetic resonance imaging, and an average of 3.03 follow‐up 18F‐florbetapir positron emission tomography scans. Distinct Aβ trajectory patterns were classified using latent class growth analysis, and longitudinal cognitive performances across these patterns were assessed with a linear mixed effects model.The optimal model consisted of three classes, with a high entropy value of 0.947. The classes were designated as follows: class 1, non‐accumulation group (n  = 197); class 2, late accumulation group (n  = 70); and class 3, early accumulation group (n  = 30). The late accumulation and early accumulation groups had more APOE ε4 carriers than the non‐accumulation group. The longitudinal analysis of cognitive performance revealed that the early accumulation group showed the steepest decline (modified Preclinical Alzheimer's Cognitive Composite with digit symbol substitution [mPACCdigit], p < 0.001; modified Preclinical Alzheimer's Cognitive Composite with trails B [mPACCtrailsB], p < 0.001) and the late accumulation group showed a steeper decline (mPACCdigit, p = 0.014; mPACCtrailsB, p = 0.007) compared to the non‐accumulation group.Our study showed the heterogeneity of Aβ accumulation trajectories in CU older individuals. The prognoses for cognitive decline differ according to the Aβ trajectory patterns. [ABSTRACT FROM AUTHOR]

An experimental study to investigate the flow of liquid jet issued from a high aspect ratio nozzle slit into an incoming airflow by changing the orientation angle from the incoming free-stream was performed. A two-dimensional liquid sheet emerged from the narrow slit into the subsonic air crossflow. Different orientation angles between 0 and 90 degrees were studied. High-speed photography and shadowgraphy techniques were utilized to visualize the flow physics. The influence of the slit orientation angle on the flow morphology and the flow regimes of liquid sheets was investigated. Some fluid flow parameters were obtained by analyzing the images. The changes in breakup height of different orientations were measured. A model was offered for the breakup height of the liquid sheet based on the liquid-to-gas momentum ratio, gas Weber number, and a new non-dimensional parameter as a representation of the angle of slit orientation. Also, the defined sheet trajectory for each orientation angle was obtained, and the variations were examined. Empirical correlations for the defined trajectory of the sheet in terms of liquid to gas momentum ratio and gas Weber number for each orientation angle were proposed. [ABSTRACT FROM AUTHOR]

Background: Although high-density lipoprotein cholesterol (HDL-C) exerts a significant influence on the development of metabolic dysfunction-associated fatty liver disease (MAFLD), the association of dynamic changes in HDL-C levels with the risk of MAFLD remains unclear. Thus, the aim of the current study was to explore the association between the changing trajectories of HDL-C and new-onset MAFLD. The findings of this study may provide a theoretical basis for future personalized intervention and prevention targeting MAFLD. Methods: A total of 1507 participants who met the inclusion criteria were recruited from a community-based physical examination population in Nanjing, China from 2017 to 2021. Group-based trajectory models were constructed to determine the heterogeneous HDL-C trajectories. The incidence of MAFLD in each group in 2022 was followed up, and the Cox proportional hazards regression model was applied to investigate the associations between different HDL-C trajectories and the risk of new-onset MAFLD. Results: The incidences of MAFLD in the low-stable, moderate-stable, moderate-high-stable, and high-stable groups of HDL-C trajectory were 26.5%, 13.8%, 7.2% and 2.6%, respectively. The incidence rate of MAFLD in the order of the above trajectory groups exhibited a decreasing trend (χ2 = 72.55, Ptrend<0.001). After adjusting for confounders, the risk of MAFLD onset in HDL-C low-stable group was still 5.421 times (95%CI: 1.303–22.554, P = 0.020) higher than that in the high-stable group. Subgroup analyses of the combined (moderate high-stable and high-stable groups combined), moderate-stable and low-stable groups showed that sex, age, and overweight/obesity did not affect the association between HDL-C trajectory and MAFLD risk. Conclusions: Persistently low HDL-C level is a risk factor for the onset of MAFLD. Long-term monitoring of HDL-C levels and timely intervention for those experiencing persistent declines are crucial for early prevention of MAFLD. [ABSTRACT FROM AUTHOR]

This study examined the relations between trajectories of temperamental shyness and attention shifting in Chinese children, the heterogeneity in these trajectories, and how psychosocial adjustment at entry to elementary school varied depending on different trajectories. The participants of 2009 and 2010 cohorts (N = 268, 51% male; Mage = 3.68 years at T1) were recruited from Yinchuan, China. On average, temperamental shyness declined and attention shifting increased over a 4‐year span from preschool to the first grade, with a negative relation between the two linear slopes, and substantial heterogeneity found in both trajectories. Children characterized by High‐Fluctuating temperamental shyness and Low‐Stable attention shifting trajectories adjusted worse than other children when they entered elementary school. The findings provide preliminary support for the top‐down model of attention shifting in the development of temperamental shyness in the Chinese context. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a heterogeneous syndrome. This study aimed to identify new sepsis sub-phenotypes using plasma cortisol trajectory. Methods: This retrospective study included patients with sepsis admitted to the intensive care unit of Zhongshan Hospital Fudan University between March 2020 and July 2022. A group-based cortisol trajectory model was used to classify septic patients into different sub-phenotypes. The clinical characteristics, biomarkers, and outcomes were compared between sub-phenotypes. Results: A total of 258 patients with sepsis were included, of whom 186 were male. Patients were divided into two trajectory groups: the lower-cortisol group (n = 217) exhibited consistently low and slowly declining cortisol levels, while the higher-cortisol group (n = 41) showed relatively higher levels in comparison. The 28-day mortality (65.9% vs.16.1%, P < 0.001) and 90-day mortality (65.9% vs. 19.8%, P < 0.001) of the higher-cortisol group were significantly higher than the lower-cortisol group. Multivariable Cox regression analysis showed that the trajectory sub-phenotype (HR = 5.292; 95% CI 2.218–12.626; P < 0.001), APACHE II (HR = 1.109; 95% CI 1.030–1.193; P = 0.006), SOFA (HR = 1.161; 95% CI 1.045–1.291; P = 0.006), and IL-1β (HR = 1.001; 95% CI 1.000–1.002; P = 0.007) were independent risk factors for 28-day mortality. Besides, the trajectory sub-phenotype (HR = 4.571; 95% CI 1.980–10.551; P < 0.001), APACHE II (HR = 1.108; 95% CI 1.043–1.177; P = 0.001), SOFA (HR = 1.270; 95% CI 1.130–1.428; P < 0.001), and IL-1β (HR = 1.001; 95% CI 1.000–1.001; P = 0.015) were also independent risk factors for 90-day mortality. Conclusion: This study identified two novel cortisol trajectory sub-phenotypes in patients with sepsis. The trajectories were associated with mortality, providing new insights into sepsis classification. [ABSTRACT FROM AUTHOR]

Flat objects like electronic boards are challenging samples for high-resolution X-ray computed tomography scanning because their largest dimension significantly limits the magnification using circular trajectory scans. One way to improve spatial resolution for such samples is to utilize variable zoom trajectory. During variable zoom trajectory scanning, the source-to-object distance changes during the 360° rotation to maximize the magnification in the projections. Here, we propose an automatic variable zoom trajectory generation algorithm for arbitrary object and region of interest (ROI). We analyze how such a trajectory can enhance resolution in different cases and how isotropic is the resolution in the reconstructed volume. We demonstrate that the resolution can be improved without destroying the sample. However, the improvement is manifested mainly in directions in which we achieved the highest magnification in the projection. [ABSTRACT FROM AUTHOR]

Congenital hypothyroidism (CH) is detected through a newborn screening program in Iran, enabling early detection and prompt treatment. This study addresses the longitudinal growth trajectory of Iranian children with CH and explores associated factors during the first 3 years of life. Data from 1474 children with CH in Isfahan, Iran (2002–2022), were analyzed. Weight, height, and head circumference were measured, and z-scores for age were calculated. Group-based trajectory modeling was applied to distinct growth trajectories. Factors influencing growth patterns, including gender, treatment initiation age, delivery method, parental consanguinity, history of familial hypothyroidism, and thyroid-stimulating hormone (TSH) levels at 3–7 days, were investigated. Thirty-seven percent of children diagnosed with CH faced a delay in weight, while 36.6% experienced stunted height, and 25.7% showed a retardation in head circumference growth. The initiation of treatment, parental consanguinity, and family history of hypothyroidism varied among these groups. Children exhibiting an optimal growth pattern in the initial 3 years of life demonstrated lower average TSH levels. Conclusion: This research emphasizes the complexity of managing CH and stresses the importance of tailoring interventions based on individualized characteristics and the ongoing growth patterns of the children. Future research is required to understand the intricate relationships between growth patterns and various determinants and optimize the growth and developmental outcomes of children with CH. What is Known: • Iran has a higher prevalence of congenital hypothyroidism (CH) with a nationwide screening program. • There are concerns about delayed growth in CH children, but limited research on long-term patterns and contributing factors. What is New: • Distinct patterns in weight, height, and head circumference among children with CH were identified. • Factors such as consanguinity, parental hypothyroidism, and TSH levels impact growth outcomes. • CH management is complicated, and there is a need for individualized interventions. [ABSTRACT FROM AUTHOR]

• Frailty was measured using two instruments (FRAIL scale and frailty index). • Four FRAIL trajectories were identified and three FI trajectories were identified. • A portion of Chinese older adults were experiencing a rapid progression of frailty. • Different interventions and care should be developed for older people in different frailty trajectories. This study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese. 2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors. Four FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed. Frailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers. [ABSTRACT FROM AUTHOR]

With the exponential growth of mobility data generated by IoT, social networks, and mobile devices, there is a pressing need to address privacy concerns. Our work proposes methods to reduce the computation of privacy risk evaluation on mobility datasets, focusing on reducing background knowledge configurations and matching functions, and enhancing code performance. Leveraging the unique characteristics of trajectory data, we aim to minimize the size of combination sets and directly evaluate risk for trajectories with distinct values. Additionally, we optimize efficiency by storing essential information in memory to eliminate unnecessary computations. These approaches offer a more efficient and effective means of identifying and addressing privacy risks associated with diverse mobility datasets. [ABSTRACT FROM AUTHOR]

Advances and cost reductions in Light Detection and Ranging (LiDAR) sensor technology have allowed for their implementation in detecting vehicles, cyclists, and pedestrians at signalized intersections. Most LiDAR use cases have focused on safety analyses using its high-fidelity tracking capabilities. This study presents a methodology to transform LiDAR data into localized, verified, and linear-referenced trajectories to derive Purdue Probe Diagrams (PPDs). The following four performance measures are then derived from the PPDs: arrivals on green (AOG), split failures (SF), downstream blockage (DSB), and control delay level of service (LOS). Noise is filtered for each detected vehicle by iteratively projecting each sample's future location and keeping the subsequent sample that is close enough to the estimated destination. Then, a far side is defined for the analyzed intersection's movement to linear reference sampled trajectories and to remove those that do not cross through that point. The technique is demonstrated by using over one hour of LiDAR data at an intersection in Utah to derive PPDs. Signal performance is then estimated from these PPDs. The results are compared to those obtained from comparable PPDs derived from connected vehicle (CV) trajectory data. The generated PPDs from both data sources are similar, with relatively modest differences of 1% AOG and a 1.39 s/veh control delay. Practitioners can use the presented methodology to estimate trajectory-based traffic signal performance measures from their deployed LiDAR sensors. The paper concludes by recommending that unfiltered LiDAR data are used for deriving PPDs and extending the detection zones to cover the largest observed queues to improve performance estimation reliability. [ABSTRACT FROM AUTHOR]

Abstract Backgrounds Cancer antigen 125 (CA125) is widely used for screening ovarian cancer (OC), yet its effectiveness remains debated. Potential factors may include ineffective cut-off value for CA125 in screening, as well as a lack of consideration for CA125 trajectories and trajectory-specific progression. Methods Based on data from multiple rounds of CA125 tests and transvaginal ultrasound (TVU) examinations conducted on 28,456 women in the PLCO Trial, time-dependent receiver-operating-characteristic curves (ROCs) and area-under-the-curves (tdAUCs) analyses were employed to identify the optimal CA125 cut-off values for OC screening. Participants were categorized into four CA125 trajectories: stable negative CA125 (CA125SN), loss of positive CA125 (CA125LP), stable positive CA125 (CA125SP), and gain of positive CA125 (CA125GP). The associations between different CA125 trajectories, trajectory-specific progression indicators, and OC risk were explored. The effectiveness of risk-stratified CA125 screening, incorporating CA125 trajectories, trajectory-specific progression, and TVU, was evaluated using hazard ratio and 95% confidence intervals [HR (95%CIs)], with adjustments for potential confounders. Results After a median follow-up of 14.8 years for OC incidence and 23.8 years for OC mortality, 250 OC cases and 218 OC deaths were identified. The tdAUC for 10-year OC incidence with CA125 was 0.663, with an optimal cut-off value of 13.00 U/ml. Trajectory analyses showed that both CA125SP and CA125GP were significantly associated with increased risks of OC incidence [HRs (95%CIs): 2.00(1.47–2.73) and 3.06(2.25–4.16)] and mortality [HRs (95%CIs):1.58(1.13–2.21) and 2.60(1.87–3.62)] compared to CA125SN. Trajectory-specific progression analyses identified relative velocity as the optimal progression indicators for both CA125SP and CA125GP (tdAUCs: 0.712 and 0.767), with optimal cut-off values of 9% and 32% per year, respectively. Positive progression was associated with significantly increased risks of OC incidence [HRs (95%CI): 7.26(4.00-13.17) and 3.83(1.96–7.51) CA125GP and CA125SP] and mortality [HRs (95%CI): 8.03(4.15–15.56) and 6.04(2.78–13.14)] compared to negative progression. Optimized risk-stratified CA125 screening, which integrated CA125 trajectories, trajectory-specific progression, and TVU, reduced missed OC by 3.6% and improved accuracy compared to traditional screening methods. Conclusions Incorporating CA125 trajectories and trajectory-specific progression into screening protocols enhances the identification of the population at high-risk of OC. An optimized screening strategy, which includes these factors along with TVU, is recommended to improve the effectiveness of OC screening.

Abstract Objectives To examine the correlation between healthy lifestyle patterns, their change trajectories, and the risk of multimorbidity in adults. Methods Based on two representative national cohorts, the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) including adults aged 50 years and over. We employed Cox regression, lifestyle change trajectories, and restricted mean survival times to explore the relationship between lifestyle (assessed by SCORE2, LE’8, and HLS scores) and multimorbidity. We also conducted mediation analysis to investigate the underlying mechanisms. Results A healthy lifestyle (higher LE’8, higher HLS, or lower SCORE2) can reduce the risk of multimorbidity. 2-10% lower multimorbidity risk per one-point increase in LE’8 and HLS. The hazard ratio of multimorbidity for improvements in unhealthy lifestyles or deterioration in healthy lifestyles compared to always healthy lifestyles ranged from 1.598 to 5.602. Besides, for LE’8 and HLS, participants with higher scores had a slower decrease in survival probability in ELSA. Triglyceride, C-reaction protein, fibrinogen, and cystatin C partly mediate the association between lifestyle and multimorbidity. Conclusions Keeping a healthy lifestyle over time can help reduce the risk of multimorbidity.

Abstract Background The association between changes in insulin resistance, reflected by the triglyceride-glucose (TyG) index, and mortality remains unclear. This study investigated whether longitudinal trajectories of TyG index changes are associated with all-cause and cardiovascular disease (CVD) mortality. Methods This retrospective cohort study analyzed data from 233,546 adults aged ≥ 19 years from the Korea National Health Insurance Service-National Sample Cohort. Participants were categorized as having increasing, stable, or decreasing TyG index changes during a 4-year exposure period (2009–2014). Mortality outcomes were assessed during an 8.13-year follow-up period (2015–2021). Cox proportional hazards regression and competing risk analysis were used to evaluate all-cause and CVD mortality. Results A total of 7918 mortality events, including 651 CVD deaths, were recorded. Compared with the stable group, adjusted hazard ratios for all-cause mortality were 1.09 (95% CI 1.03–1.15) in the increasing group and 1.23 (95% CI 1.01–1.50) for CVD mortality. An increased TyG index was significantly associated with all-cause mortality in individuals aged

Abstract Background Social engagement is closely related to well-being among older adults. However, studies on the changing trajectory and influencing factors (especially time-varying factors) of social engagement are limited. This study aimed to examine the social engagement trajectory of older Chinese adults and explore its time-fixed and time-varying factors, thus providing evidence for the development of strategies to promote a rational implementation for healthy aging. Methods This study included 2,195 participants from a subset of four surveys from the Chinese Longitudinal Healthy Longevity Survey conducted from 2008 to 2018 (with the latest survey completed in 2018), with follow-ups conducted approximately every three years. Growth mixture modeling was used to explore the social engagement trajectory of older adults and the effects of time-varying variables. In addition, multinomial logistic regression was employed to analyze the association between time-fixed variables and latent classes. Results Three distinct trajectories of social engagement among older adults in China were identified: slow declining (n = 204; 9.3%), which meant social engagement score decreased continuously, but social engagement level improved; slow rising (n = 1,039; 47.3%), marked by an increased score of social engagement, but with an depressed engagement level; and middle stabilizing (n = 952; 43.4%), which meant social engagement score and engagement level remained quite stable. A time-fixed analysis indicated that age, marital status, educational level, and annual family income had a significant impact on social engagement (P

Introduction: Pedicle screws are commonly used in fixation to treat various spinal disorders. However, screw loosening is a prevalent complication, particularly in patients with osteoporosis. Various biomechanical studies have sought to address this issue, but the optimal depth and trajectory to increase the fixation strength of pedicle screws remain controversial. Therefore, a biomechanical study was conducted using finite element models. Methods: Three-dimensional finite element models of the L3 vertebrae were developed from the preoperative computed tomography images of nine patients with osteoporosis and nine patients without who underwent spine surgery. Unicortical and bicortical pedicle screws were inserted into the center and into the anterior wall of the vertebrae, respectively, in different trajectories in the sagittal plane: straightforward, cephalad, and caudal. Subsequently, three different external loads were applied to each pedicle screw at the entry point: axial pullout, craniocaudal, and lateromedial loads. Nonlinear analysis was conducted to examine the fixation strength of the pedicle screws. Results: Irrespective of osteoporosis, the bicortical pedicle screws had greater fixation strength than the unicortical pedicle screws in all trajectories and external loads. The fixation strength of the bicortical pedicle screws was not substantially different among the trajectories against any external loads in the nonosteoporotic vertebrae. However, the fixation strength of the bicortical pedicle screws against craniocaudal load in the cephalad trajectory was considerably greater than those in the caudal (P=0.016) and straightforward (P=0.023) trajectories in the osteoporotic vertebrae. However, this trend was not observed in pullout and lateromedial loads. Conclusions: Our results indicate that bicortical pedicle screws should be used, regardless of whether the patient has osteoporosis or not. Furthermore, pedicle screws should be inserted in the cephalad trajectory in patients with osteoporosis.

Abstract Background Gastric cancer is the fourth most common cancer and highly prevalent in South Korea. As one of the predictors of gastric cancer, we focused on health utilization patterns and expenditures, as the surrogate variables of health conditions. This nested case-control study aimed to identify the association between health expenditure trajectory and incidence of gastric cancer. Methods Data from the National Health Insurance Service Senior Cohort of South Korea were used. Individuals diagnosed with gastric cancer (N = 14,873) were matched to a non-diagnosed group (N = 44,619) in a 1:3 ratio using a nested case-control design. A latent class trajectory analysis was performed to identify the patterns of health expenditure among the matched participants. Furthermore, conditional logistic regression analysis was conducted to examine the relationship between healthcare expenditure trajectories and gastric cancer incidence. Results Seven distinct health expenditure trajectories for five years were identified; consistently lowest (13.8%), rapidly increasing (5.9%), gradually increasing (13.8%), consistently second-highest (21.4%), middle-low (18.8%), gradually decreasing (13.1%), and consistently highest (13.2%). Compared to the middle-low group, individuals in the rapidly increasing [odds ratio (OR) = 2.11, 95% confidence interval (CI); 1.94–2.30], consistently lowest (OR = 1.40, 95% CI; 1.30–1.51), and gradually increasing (OR = 1.26, 95% CI; 1.17–1.35) groups exhibited a higher risk of developing gastric cancer. Conclusions Our findings suggest that health expenditure trajectories are predictors of gastric cancer. Potential risk groups can be identified by monitoring health expenditures.

Abstract An experimental study to investigate the flow of liquid jet issued from a high aspect ratio nozzle slit into an incoming airflow by changing the orientation angle from the incoming free-stream was performed. A two-dimensional liquid sheet emerged from the narrow slit into the subsonic air crossflow. Different orientation angles between 0 and 90 degrees were studied. High-speed photography and shadowgraphy techniques were utilized to visualize the flow physics. The influence of the slit orientation angle on the flow morphology and the flow regimes of liquid sheets was investigated. Some fluid flow parameters were obtained by analyzing the images. The changes in breakup height of different orientations were measured. A model was offered for the breakup height of the liquid sheet based on the liquid-to-gas momentum ratio, gas Weber number, and a new non-dimensional parameter as a representation of the angle of slit orientation. Also, the defined sheet trajectory for each orientation angle was obtained, and the variations were examined. Empirical correlations for the defined trajectory of the sheet in terms of liquid to gas momentum ratio and gas Weber number for each orientation angle were proposed.

Abstract Background Although high-density lipoprotein cholesterol (HDL-C) exerts a significant influence on the development of metabolic dysfunction-associated fatty liver disease (MAFLD), the association of dynamic changes in HDL-C levels with the risk of MAFLD remains unclear. Thus, the aim of the current study was to explore the association between the changing trajectories of HDL-C and new-onset MAFLD. The findings of this study may provide a theoretical basis for future personalized intervention and prevention targeting MAFLD. Methods A total of 1507 participants who met the inclusion criteria were recruited from a community-based physical examination population in Nanjing, China from 2017 to 2021. Group-based trajectory models were constructed to determine the heterogeneous HDL-C trajectories. The incidence of MAFLD in each group in 2022 was followed up, and the Cox proportional hazards regression model was applied to investigate the associations between different HDL-C trajectories and the risk of new-onset MAFLD. Results The incidences of MAFLD in the low-stable, moderate-stable, moderate-high-stable, and high-stable groups of HDL-C trajectory were 26.5%, 13.8%, 7.2% and 2.6%, respectively. The incidence rate of MAFLD in the order of the above trajectory groups exhibited a decreasing trend (χ2 = 72.55, P trend

Commercially available crowdsourced connected vehicle (CV) trajectory data have recently been used to provide stakeholders with actionable and scalable roadway mobility infrastructure performance measures. Transportation agencies and automotive original equipment manufacturers (OEMs) share a common vision of ensuring the privacy of motorists that anonymously provide their journey information. As this market has evolved, the fleet mix has changed, and some OEMs have introduced additional fuzzification of CV data around 0.5 miles of frequently visited locations. This study compared the estimated Indiana market penetration rates (MPRs) between historic non-fuzzified CV datasets from 2020 to 2023 and a 5–11 May 2024, CV dataset with fuzzified records and a reduced fleet. At selected permanent interstate and non-interstate count stations, overall CV MPRs decreased by 0.5% and 0.3% compared to 2023, respectively. However, the trend in previous years was upward. Additionally, this paper evaluated the impact on data characteristics at freeways and intersections between the 5–11 May 2024, fuzzified CV dataset and a non-fuzzified 7–13 May 2023, CV dataset. The analysis found that the total number of GPS samples decreased 10% statewide. Of the evaluated 54,284 0.1-mile Indiana freeway, US Route, and State Route segments, the number of CV samples increased for 33.8% and decreased for 65.9%. This study also evaluated 26,291 movements at 3289 intersections and found that the number of available trajectories increased for 28.3% and decreased for 70.4%. This paper concludes that data representativeness is enough to derive most relevant mobility performance measures. However, since the change in available trajectories is not uniformly distributed among intersection movements, an unintended sample bias may be introduced when computing performance measures. This may affect signal retiming or capital investment opportunity identification algorithms.

Abstract Background Depression is prevalent among lung cancer patients undergoing chemotherapy, and the symptom cluster of fatigue-pain-insomnia may influence their depression. Identifying characteristics of patients with different depression trajectories can aid in developing more targeted interventions. This study aimed to identify the trajectories of depression and the fatigue-pain-insomnia symptom cluster, and to explore the predictive factors associated with the categories of depression trajectories. Methods In this longitudinal study, 187 lung cancer patients who were undergoing chemotherapy were recruited and assessed at the first (T1), second(T2), and fourth(T3) months using the Patient Health Questionnaire-9 (PHQ-9), the Brief Pain Inventory (BPI), the Brief Fatigue Inventory (BFI), and the Athens Insomnia Scale (AIS). Growth Mixture Model (GMM) and Latent Class Analysis (LCA) were used to identify the different trajectories of the fatigue-pain-insomnia symptom cluster and depression. Binary logistic regression was utilized to analyze the predictive factors of different depressive trajectories. Results GMM identified two depressive trajectories: a high decreasing depression trajectory (40.64%) and a low increasing depression trajectory (59.36%). LCA showed that 48.66% of patients were likely members of the high symptom cluster trajectory. Binary logistic regression analysis indicated that having a history of alcohol consumption, a higher symptom cluster burden, unemployed, and a lower monthly income predicted a high decreasing depression trajectory. Conclusions Depression and fatigue-pain-insomnia symptom cluster in lung cancer chemotherapy patients exhibited two distinct trajectories. When managing depression in these patients, it is recommended to strengthen symptom management and pay particular attention to individuals with a history of alcohol consumption, unemployed, and a lower monthly income.

Abstract Background A high triglyceride-glucose index (TyG) is associated with a higher risk of incident heart failure. However, the effects of longitudinal patterns of TyG index on the risk of heart failure remain to be characterized. Therefore, in the present study, we aimed to characterize the relationship between the trajectory of TyG index and the risk of heart failure. Methods We performed a prospective study of 56,149 participants in the Kailuan study who attended three consecutive surveys in 2006–2007, 2008–2009, and 2010–2011 and had no history of heart failure or cancer before the third wave survey (2010–2011). The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2], and we used latent mixture modeling to characterize the trajectory of the TyG index over the period 2006–2010. Additionally, Cox proportional risk models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for incident heart failure for the various TyG index trajectory groups. Results From 2006 to 2010, four different TyG trajectories were identified: low-stable (n = 13,554; range, 7.98–8.07), moderate low-stable (n = 29,435; range, 8.60–8.65), moderate high-stable (n = 11,262; range, 9.31–9.30), and elevated-stable (n = 1,898; range, 10.04–10.25). A total of 1,312 new heart failure events occurred during a median follow-up period of 10.04 years. After adjustment for potential confounders, the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident heart failure for the elevated-stable, moderate high-stable, and moderate low-stable groups were 1.55 (1.15, 2.08), 1.32 (1.08, 1.60), and 1.17 (0.99, 1.37), respectively, compared to the low-stable group. Conclusions Higher TyG index trajectories were associated with a higher risk of heart failure. This suggests that monitoring TyG index trajectory may help identify individuals at high risk for heart failure and highlights the importance of early control of blood glucose and lipids for the prevention of heart failure.

Abstract Background The atherogenic index of plasma (AIP) has been shown to be positively correlated with cardiovascular events. However, it remains unclear whether hypertensive patients with long-term high AIP levels are at greater risk of developing heart failure (HF). Therefore, the aim of this study was to investigate the association between AIP trajectory and the incidence of HF in hypertensive patients. Methods This prospective study included 22,201 hypertensive patients from the Kailuan Study who underwent three waves of surveys between 2006 and 2010. Participants were free of HF or cancer before or during 2010. The AIP was calculated as the logarithmic conversion ratio of triglycerides to high-density lipoprotein cholesterol. Latent mixed modeling was employed to identify different trajectory patterns for AIP during the exposure period (2006–2010). Cox proportional hazard models were then used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for incident HF among different trajectory groups. Results Four distinct trajectory patterns were identified through latent mixture modeling analysis: low-stable group (n = 3,373; range, -0.82 to -0.70), moderate-low stable group (n = 12,700; range, -0.12 to -0.09), moderate-high stable group (n = 5,313; range, 0.53 to 0.58), and elevated-increasing group (n = 815; range, 1.22 to 1.56). During a median follow-up period of 9.98 years, a total of 822 hypertensive participants experienced HF. After adjusting for potential confounding factors, compared with those in the low-stable group, the HR and corresponding CI for incident HF in the elevated-increasing group, moderate-high stable group, and moderate-low stable group were estimated to be 1.79 (1.21,2.66), 1.49 (1.17,1.91), and 1.27 (1.02,1.58), respectively. These findings remained consistent across subgroup analyses and sensitivity analyses. Conclusion Prolonged elevation of AIP in hypertensive patients is significantly associated with an increased risk of HF. This finding suggests that regular monitoring of AIP could aid in identifying individuals at a heightened risk of HF within the hypertensive population.

Advances and cost reductions in Light Detection and Ranging (LiDAR) sensor technology have allowed for their implementation in detecting vehicles, cyclists, and pedestrians at signalized intersections. Most LiDAR use cases have focused on safety analyses using its high-fidelity tracking capabilities. This study presents a methodology to transform LiDAR data into localized, verified, and linear-referenced trajectories to derive Purdue Probe Diagrams (PPDs). The following four performance measures are then derived from the PPDs: arrivals on green (AOG), split failures (SF), downstream blockage (DSB), and control delay level of service (LOS). Noise is filtered for each detected vehicle by iteratively projecting each sample’s future location and keeping the subsequent sample that is close enough to the estimated destination. Then, a far side is defined for the analyzed intersection’s movement to linear reference sampled trajectories and to remove those that do not cross through that point. The technique is demonstrated by using over one hour of LiDAR data at an intersection in Utah to derive PPDs. Signal performance is then estimated from these PPDs. The results are compared to those obtained from comparable PPDs derived from connected vehicle (CV) trajectory data. The generated PPDs from both data sources are similar, with relatively modest differences of 1% AOG and a 1.39 s/veh control delay. Practitioners can use the presented methodology to estimate trajectory-based traffic signal performance measures from their deployed LiDAR sensors. The paper concludes by recommending that unfiltered LiDAR data are used for deriving PPDs and extending the detection zones to cover the largest observed queues to improve performance estimation reliability.

Since the end of the 20th century, the imaginary of living being reducible to its genetic information has been a decisive factor in the generalization of biotech considered as a set of new innovation practices associating the academic and industrial worlds, particularly in the medical sector. This article suggests that there multiple socio-technical imaginaries of the living that could be used to adapt the biotechnology innovation model beyond the medical sector. Based on the trajectory of a scientific and economic project aimed at getting microorganisms to produce a small molecule between the early 1990s and the mid-2010s in France and North America, this article argues two things. Firstly, it describes how the notions of platform molecules and metabolic pathways are at the heart of a biochemical imaginary of the living, updating an ancient vision of the living that has been erased by the rise of genetic engineering. On the other hand, the article shows how certain properties of this biochemical living are mobilized to adapt the biotechnology model to the industrial chemistry sector and to new territories.