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Background: New daily persistent headache (NDPH) is a continuous, unremitting headache from onset that yields suboptimal results with traditional medicines. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising non-invasive treatment for other headache disorders, such as migraine, and neuromodulation has not been well-studied in NDPH. The objective of the study was to evaluate the efficacy of rTMS in reducing the frequency and severity of headaches, and associated anxiety and depressive symptoms in NDPH patients. Methods: This was an open label prospective, single arm, interventional pilot study conducted between October 2022 and September 2023. All eligible participants received 10 Hz rTMS (600 pulses, 10 trains), delivered to the left prefrontal cortex for three consecutive days. The post-rTMS headache severity was recorded weekly for four weeks and headache free days/functional disability, PHQ-9, and GAD-7 scores at the end of four weeks and compared with pre-rTMS parameters. The primary outcome was defined by ≥ 50% reduction in headache severity on Visual Analogue Scale (VAS) score, decrease in headache days from the baseline and secondary outcome was ≥ 6 point reduction in HIT-6 score at 4 weeks. Results: Fifty NDPH patients (mean [SD] age, 35.06 [13.91] years; 31 females [62%]) participated in this study. Thirty-five patients (70%) reported ≥ 50% improvement in pain severity (p-value < 0.001), with a mean reduction of 10.84 (4.88) headache days per 28 days from a baseline of 28 headache days (p-value < 0.001). Thirty-eight patients (76%) reported a ≥ 6 point's reduction in HIT score at 4 weeks. Maximum improvement in the above parameters was observed in NDPH patients with chronic migraine. Two patients reported intolerance to the sound of the rTMS. The median (IQR) PHQ-9 and GAD-7 scores reduced from 11.5(3.75,20) to 7(2,15) (p-value < 0.001) and 10(3,14) to 5.5(0,9) (p-value < 0.001) respectively. Conclusion: rTMS was well tolerated and effective in reducing pain severity, headache days and headache related disability, depressive and anxiety symptoms. Trial registration: CTRI/2023/05/053247. [ABSTRACT FROM AUTHOR]

Background: Improvements in oxygenation and lung mechanics with prone position (PP) in patients with acute respiratory distress syndrome (ARDS) are inconstant. The objectives of the study were (i) to identify baseline variables, including the recruitment-to-inflation ratio (R/I), associated with a positive response to PP in terms of oxygenation (improvement of the ratio of arterial oxygen partial pressure over the inspired oxygen fraction (PaO2/FiO2) ≥ 20 mmHg) and lung mechanics; (ii) to evaluate whether the response to the previous PP session is associated with the response to the next session. Methods: In this prospective, observational, single-center study in patients who underwent PP for ARDS due to COVID-19, respiratory variables were assessed just before PP and at the end of the session. Respiratory variables included mechanical ventilation settings and respiratory mechanics variables, including R/I, an estimate of the potential for lung recruitment compared to lung overinflation. Results: In 50 patients, 201 PP sessions lasting 19 ± 3 h were evaluated. Neuromuscular blockades were used in 116 (58%) sessions. The PaO2/FiO2 ratio increased from 109 ± 31 mmHg to 165 ± 65 mmHg, with an increase ≥ 20 mmHg in 142 (71%) sessions. In a mixed effect logistic regression, only pre-PP PaO2/FiO2 (OR 1.12 (95% CI [1.01–1.24])/every decrease of 10 mmHg, p = 0.034) in a first model and improvement in oxygenation at the previous PP session (OR 3.69 (95% CI [1.27–10.72]), p = 0.017) in a second model were associated with an improvement in oxygenation with PP. The R/I ratio (n = 156 sessions) was 0.53 (0.30–0.76), separating lower- and higher-recruiters. Whereas PaO2/FiO2 improved to the same level in both subgroups, driving pressure and respiratory system compliance improved only in higher-recruiters (from 14 ± 4 to 12 ± 4 cmH2O, p = 0.027, and from 34 ± 11 to 38 ± 13 mL/cmH2O, respectively, p = 0.014). Conclusions: A lower PaO2/FiO2 at baseline and a positive O2-response at the previous PP session are associated with a PP-induced improvement in oxygenation. In higher-recruiters, lung mechanics improved along with oxygenation. Benefits of PP could thus be greater in these patients. [ABSTRACT FROM AUTHOR]

Background: Frozen shoulder is an incapacitating disease that causes pain and limitation in the shoulder joint functional capacity. This work aimed to assess the efficacy of ultrasound-guided combined intra-articular corticosteroids (CS) injection and suprascapular nerve block (SSNB) in pain control in patients with frozen shoulders. Results: Our prospective study included 40 patients, equally divided into two groups: group A; managed with combined ultrasound (US) guided intra-articular corticosteroids injection (IACSI) and SSNB, and group B patients managed with US-guided SSNB. The visual analog scale score statistically significantly improved after both injections. This success was maintained and showed mild improvement at 8-week intervals (with increased patient capability to do physiotherapy after pain control). Similarly, improvement in the functional capacity of the shoulder joint was identified and assessed by the Oxford shoulder score (OSS) in both groups. Mean OSS was statistically significantly higher at 4-week intervals than before the nerve block for groups A and B. At 8 weeks interval, this favorable result was sustained (p <.001). Conclusions: US-guided SSNB is an effective, radiation-free method to alleviate frozen shoulder-related pains. However, US-guided combined SSNB and IACSI was more effective than SSNB alone in both pain alleviation and improved shoulder joint function. [ABSTRACT FROM AUTHOR]

Background: Aging has been defined as a persistent deterioration in the age-specific fitness components of an organism, attributed to internal physiological degeneration. Cognitive abilities, encompassing attention, memory, executive cognitive functions, language, and visuospatial capacities, are distinctive domains affected by aging. Numerous studies have documented measurable effects on these cognitive domains, indicating a discernible decline in their functionality with advancing age. Cognitive impairment often unfolds insidiously, remaining clinically silent for extended periods. Age, as a critical factor, exerts a notable influence on P300 measures. Result: Spearman rank correlation was calculated between age and P300 measures. In group 1A (age range of 10–20 years), we found a strong positive correlation between age and amplitude of P300 (r = 0.96, p < 0.001), while a weak correlation was found between latency and age. In group IB (age range: 21–40 years), a moderate negative correlation (r = − 0.43, p < 0.05) was found between age and amplitude of P300, while a strong positive correlation (r = 0.87, p < 0.001) was obtained between age and latency. In group 2A (age: 41–60 years), it was found that amplitude has a strong negative correlation (r = − 0.97, p < 0.001) with age, while latency has a strong positive correlation (r = 0.89, p < 0.001). In group 2B (age: 61–80 years), it was found that amplitude has a strong negative correlation (r = − 0.93, p < 0.001) with age, while latency has a strong positive correlation (r = 0.95, p < 0.001). Conclusion: In this study, it is concluded that amplitude of P300 decreases and latency increases with increasing age. [ABSTRACT FROM AUTHOR]

E-mental health (EMH) interventions gain increasing importance in the treatment of mental health disorders. Their outpatient efficacy is well-established. However, research on EMH in inpatient settings remains sparse and lacks a meta-analytic synthesis. This paper presents a meta-analysis on the efficacy of EMH in inpatient settings. Searching multiple databases (PubMed, ScienceGov, PsycInfo, CENTRAL, references), 26 randomized controlled trial (RCT) EMH inpatient studies (n = 6112) with low or medium assessed risk of bias were included. A small significant total effect of EMH treatment was found (g = 0.3). The effect was significant both for blended interventions (g = 0.42) and post-treatment EMH-based aftercare (g = 0.29). EMH treatment yielded significant effects across different patient groups and types of therapy, and the effects remained stable post-treatment. The results show the efficacy of EMH treatment in inpatient settings. The meta-analysis is limited by the small number of included studies. [ABSTRACT FROM AUTHOR]

Background: Presbycusis is known to accelerate mental decline processes and to cause secondary consequences such as social isolation and depression when not intervened. The association of presbycusis and presbyvestibulopathy disorders is likely. These changes in vestibular functions are closely related to cognitive functions. This study investigated the effect of hearing loss on cognitive and vestibular functions in a geriatric population. Methods: This study was conducted with 200 participants over the age of 65. The study was conducted with three groups: individuals with normal hearing, moderate sensorineural hearing loss, and severe sensorineural hearing loss. The relationship between the participants' responses to the Cognitive Vestibular Function Scale and their hearing levels was examined. Results: Of the individuals with hearing loss in the study group, 55 had moderate SNHL, and 45 had severe SNHL. The age range of the participants was 65 to 91 years (71.06 ± 4.92). When the control (Group N) and study groups (Group M and Group S) were compared according to CVFS and subscale scores, they were found to be statistically different (p < 0.05). In pairwise comparisons, a significant difference (p < 0.05) was found in all pairwise combinations except Group N and Group M (p = 0.109) for the VSM subscale. Conclusions: It was concluded that having a healthy hearing is the most influential factor for maintaining cognitive vestibular functions in the geriatric population. It was found that the degree of hearing loss primarily affects cognitive vestibular functions and that cognitive vestibular functions deteriorate more as hearing loss increases. [ABSTRACT FROM AUTHOR]

The Tibetan sheep industry is a typical representative of plateau animal husbandry and grassland animal husbandry and is also one of the characteristic industries in the Qinghai-Tibet Plateau region. The study of this industry is of great significance to promoting the high-quality development of animal husbandry and the region. Based on the production data and statistical data of Tibetan sheep in the main producing areas of Qinghai Province, this paper adopts the entropy method and the coupling coordination degree model to study the high-quality development of animal husbandry in Qinghai province from five dimensions: product quality, production efficiency, economic benefits, environmental friendliness and environmental conditions. The results showed that the high-quality development level and coupling coordination degree of the Tibetan sheep industry in Haibei Prefecture, Hainan Prefecture, Haixi Prefecture and Huangnan Prefecture of Qinghai Province showed an upward trend from 2015 to 2020. Among them, the high-quality development level of the Tibetan sheep industry in Haibei Prefecture and Hainan Prefecture of Qinghai Province significantly increased from 2019 to 2020, but the coupling coordination degree decreased. [ABSTRACT FROM AUTHOR]

Background: Cardiac arrest remains a global health issue with limited data on long-term outcomes, particularly regarding recurrent cardiovascular events in patients surviving out-of-hospital cardiac arrest. (OHCA). We aimed to describe the long-term occurrence of major cardiac event defined by hospital admission for cardiovascular events or death in OHCA hospital survivors, whichever came first. Our secondary objective were to assess separately occurrence of hospital admission and death, and to identify the factors associated with major event occurrence. We hypothesized that patients surviving an OHCA has a protracted increased risk of cardiovascular events, due to both presence of the baseline conditions that lead to OHCA, and to the cardiovascular consequences of OHCA induced acute ischemia-reperfusion. Methods: Consecutive OHCA patients from three hospitals of Sudden Death Expertise Center (SDEC) Registry, discharged alive from 2011 to 2015 were included. Long-term follow-up data were obtained using national inter-regime health insurance information system (SNIIRAM) database and the national French death registry. The primary endpoint was occurrence of a major event defined by hospital admission for cardiovascular events and death, whichever came first during the follow-up. The starting point of the time-to-event analysis was the date of hospital discharge. The follow-up was censored on the date of the first event. For patients without event, follow-up was censored on the date of December, 29th, 2016. Results: A total of 306 patients (mean age 57; 77% male) were analyzed and followed over a median follow-up of 3 years for hospital admission for cardiovascular event and 6 years for survival. During this period, 38% patients presented a major event. Hospital admission for cardiovascular events mostly occurred during the first year after the OHCA whereas death occurred more linearly during the all period. A previous history of chronic heart failure and coronary artery disease were independently associated with the occurrence of major event (HR 1.75, 95%CI[1.06-2.88] and HR 1.70, 95%CI[1.11-2.61], respectively), whereas post-resuscitation myocardial dysfunction, cardiogenic shock and cardiologic cause of cardiac arrest did not. Conclusion: Survivors from OHCA must to be considered at high risk of cardiovascular event occurrence whatever the etiology, mainly during the first year following the cardiac arrest and should require closed monitoring. [ABSTRACT FROM AUTHOR]

Chat Generative Pretrained Transformer (ChatGPT; OpenAI) is a state-of-the-art large language model that can simulate human-like conversations based on user input. We evaluated the performance of GPT-4 V in the Japanese National Clinical Engineer Licensing Examination using 2,155 questions from 2012 to 2023. The average correct answer rate for all questions was 86.0%. In particular, clinical medicine, basic medicine, medical materials, biological properties, and mechanical engineering achieved a correct response rate of ≥ 90%. Conversely, medical device safety management, electrical and electronic engineering, and extracorporeal circulation obtained low correct answer rates ranging from 64.8% to 76.5%. The correct answer rates for questions that included figures/tables, required numerical calculation, figure/table ∩ calculation, and knowledge of Japanese Industrial Standards were 55.2%, 85.8%, 64.2% and 31.0%, respectively. The reason for the low correct answer rates is that ChatGPT lacked recognition of the images and knowledge of standards and laws. This study concludes that careful attention is required when using ChatGPT because several of its explanations lack the correct description. [ABSTRACT FROM AUTHOR]

Background: Although artificial intelligence (AI) has potential in the field of screening of breast cancer, there are still issues. It is vital to make sure AI does not overlook cancer or cause needless recalls. The aim of this work was to investigate the effectiveness of indulging AI in combination with one radiologist in the routine double reading of mammography for breast cancer screening. The study prospectively analyzed 32,822 screening mammograms. Reading was performed in a blind-paired style by (i) two radiologists and (ii) one radiologist paired with AI. A heatmap and abnormality scoring percentage were provided by AI for abnormalities detected on mammograms. Negative mammograms and benign-looking lesions that were not biopsied were confirmed by a 2-year follow-up. Results: Double reading by the radiologist and AI detected 1324 cancers (6.4%); on the other side, reading by two radiologists revealed 1293 cancers (6.2%) and presented a relative proportion of 1·02 (p < 0·0001). At the recall stage, suspicion and biopsy recommendation were more presented by the AI plus one radiologist combination than by the two radiologists. The interpretation of the mammogram by AI plus only one radiologist showed a sensitivity of 94.03%, a specificity of 99.75%, a positive predictive value of 96.571%, a negative predictive value of 99.567%, and an accuracy of 99.369% (from 99.252 to 99.472%). The positive likelihood ratio was 387.260, negative likelihood ratio was 0.060, and AUC "area under the curve" was 0.969 (0.967–0.971). Conclusions: AI could be used as an initial reader for the evaluation of screening mammography in routine workflow. Implementation of AI enhanced the opportunity to reduce false negative cases and supported the decision to recall or biopsy. [ABSTRACT FROM AUTHOR]

Quantum computing is an exciting field with high disruptive potential, but very difficult to access. For this reason, many approaches to teaching quantum computing are being developed worldwide. This always raises questions about the didactic concept, the content actually taught, and how to measure the success of the teaching concept. In 2022 and 2023, the authors taught a total of nine two-week MOOCs (massive open online courses) with different possible learning paths on the Hasso Plattner Institute's OpenHPI platform. The purpose of the platform is to make computer science education available to everyone free of charge. The nine quantum courses form a self-contained curriculum. A total of more than 17,000 course attendances have been taken by about 7400 natural persons, and the number is still rising. This paper presents the course concept and evaluates the anonymized data on the background of the participants, their behaviour in the courses, and their learning success. This paper is the first to analyze such a large dataset of MOOC-based quantum computing education. The summarized results are a heterogeneous personal background of the participants biased towards IT professionals, a majority following the didactic recommendations, and a high success rate, which is strongly correlatated with following the didactic recommendations. The amount of data from such a large group of quantum computing learners provides many avenues for further research in the field of quantum computing education. The analyses show that the MOOCs are a low-threshold concept for getting into quantum computing. It was very well received by the participants. The concept can serve as an entry point and guide for the design of quantum computing courses. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a global health threat. This randomized controlled trial evaluates the impact of experiential virtual reality (VR) versus information provision via VR or leaflet on prudent antibiotic use. A total of 249 (239 analyzed) participants were randomized into three conditions: VR Information + Experience, VR Information, or Leaflet Information. All participants received AMR information, while those in the VR Information + Experience condition additionally engaged in a game, making treatment decisions for their virtual avatar's infection. Participants in the VR Information + Experience condition showed a significant increase in prudent use intentions from baseline (d = 1.48). This increase was significantly larger compared to the VR Information (d = 0.50) and Leaflet Information (d = 0.79) conditions. The increase in intentions from baseline remained significant at follow-up in the VR Information + Experience condition (d = 1.25). Experiential VR communication shows promise for promoting prudent antibiotics use. [ABSTRACT FROM AUTHOR]

Background: The University of Jyvaskyla Active Aging Scale (UJACAS) assesses active aging through willingness, ability, opportunity, and frequency of involvement in activities. Recognizing the lack of a German version, the Finnish original was translated (UJACAS-G). This study aimed: (1) to evaluate the test-retest reliability of UJACAS-G; and (2) to explore correlations with health-related parameters (concurrent validity). Methods: The study (test-retest design) targeted healthy older adults aged 65+. Reliability of UJACAS-G (total and subscores) was assessed using Bland-Altman analyses and Intraclass Correlation Coefficients (ICCs). Furthermore, correlations (Spearman's rho) between UJACAS-G scores and physical function (walking speed, handgrip strength, balance, 6-minute walk distance), physical activity (International Physical Activity Questionnaire), life-space mobility (Life-Space Assessment), and health-related quality of life (Short Form-36 Health Survey) were calculated. Results: Bland-Altman analyses (N = 60; mean age 72.3, SD 5.9 years; 50% women) revealed mean differences close to zero and narrow limits of agreement for all scores (total score: mean difference −1.9; limits −31.7 to 27.9). The ability subscore showed clustering at its upper limit. ICC was 0.829 (95% CI 0.730 to 0.894) for the total score and ranged between 0.530 and 0.876 for subscores (all p-values < 0.001). The total score correlated with walking speed (rho = 0.345; p = 0.008), physical activity (rho = 0.279; p = 0.033) and mental health (rho = 0.329; p = 0.010). Conclusions: UJACAS-G is reliable for assessing active aging among German-speaking healthy older adults. A potential 'ceiling effect' regarding the ability subscore should be considered when applying UJACAS-G to well-functioning populations. Analyses of concurrent validity indicated only weak correlations with health-related parameters. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disorder characterized by synovial inflammation that leads to joint damage, bony erosions, and related deformities. Between 30 and 70% of RA patients will experience anemia. Early detection of anemia is of great importance. This study aimed to evaluate the serum level of hepcidin (HEP) in RA patients and to assess its relation to disease activity and anemia. The current cross-sectional study included 44 cases with RA in addition to 44 healthy controls. The disease activity in the RA patient was assessed by using the disease activity score (DAS) 28 score-CRP. The serum levels of HEP and ferritin were assessed in both groups using enzyme-linked immunosorbent assay (ELISA) technique. Results: Hepcidin level in the RA group was statistically significantly higher as compared to the control group (p = 0.001). The prevalence of Anemia of chronic disease (ACD) was 40.9%, and iron deficiency anemia (IDA) was 27.3% which accounted for 68.2% of the total anemia cases. The HEP level was statistically significantly higher in the RA patients with ACD than those without anemia (P = 0.028), RA patients with IDA (P < 0.001), and control group (P < 0.001). There was a statistically significant positive correlation between HEP level and serum ferritin level (p = 0.005). HEP level was significantly and inversely correlated with hemoglobin (Hb) in patients with ACD. Serum HEP level is higher in RA patients with high disease activity than those with moderate activity, low activity, and patients in remission (p = 0.380). However, the difference was not statistically significant. The best cutoff point of HEP level to identify RA patients from healthy controls was > 355.5 Pg/ml. This point showed moderate sensitivity (70.5%) with moderate specificity (63.6%) with a statistically significant value. Conclusions: We found the anemia, and particularly ACD, is more common in RA patients. In RA patients with ACD, serum HEP levels were considerably higher. Although serum HEP showed no diagnostic significance when it came to evaluating disease activity, it could be a dependable non-invasive biomarker for the diagnosis of various forms of anemia in RA patients. [ABSTRACT FROM AUTHOR]

Activities and falls monitoring systems using wearable technology have a promising future. The publicly available datasets are based on a few inertial features only acquired with an accelerometer, gyroscope, smartphone or smart Watches. The activities and falls performed are also less. In this study, a dataset is created by collecting physiological features along with inertial features which will help in developing and validating systems studying the effect of physiological features on the detection and prediction of falls and activities. The dataset consists of 7 activities and 8 falls for inertial data; 2 activities for ECG data; 6 activities for EMG data and 6 activities for GSR data. Basic body parameters like height, weight, etc. along with beats per minute, SpO2 and blood pressure are also recorded for 12 subjects. The collected data is analyzed statistically using a boxplot, pair plot, correlation heatmap and p value. The activities are classified using SVM, KNN, RF and DT. For GSR, more than 90% accuracy is achieved and for EMG, the accuracy is less than 80%. For IMU data, more than 95% accuracy is achieved. The results encourage combining inertial, physiological and basic body parameters to detect and predict falls and activities. [ABSTRACT FROM AUTHOR]

Developing efficient and secure image encryption techniques for transmitting multiple images has become crucial due to the inadequacy of single-image encryption techniques in handling the increasing volume of big data over unprotected networks. This paper introduces a novel multiple-image encryption (MIE) technique that utilizes mixed image elements in conjunction with the RSA cryptosystem, fractional discrete cosine transform (FrDCT), and Henon chaotic map (HCM). To encrypt k images together, the first step involves making three big images B 1 , B 2 and B 3 from these k images using matrix theory. The three images B 1 , B 2 and B 3 are converted into three indexed images I 1 , I 2 , and I 3 by extracting their color maps. Indexed images I 1 , I 2 and I 3 are then treated as a single RGB image by taking I 1 as a red (R) component, I 2 as a green (G) component and I 3 as a blue (B) component. The RSA cryptosystem is then applied on each component individually, followed by FrDCT and HCM to enhance security and key space. The resulting encrypted image is a single-channel real-valued image that is easy to display, store, and transmit over an unsecured network. The suggested technique offers multi-layer security in frequency, time and coordinate domains. Private keys, their arrangements and parameter positions are critical for decryption. Simulation analysis supports the robustness and effectiveness of the proposed technique. The sensitivity analysis demonstrates its extreme sensitivity towards private keys and their arrangement. Statistical analysis, including measures such as MSE, SSIM, PSNR, NPCR, UACI, entropy analysis, correlation coefficient, histogram analysis, computational complexity and comparison analysis confirm the effectiveness and viability of the introduced algorithm. [ABSTRACT FROM AUTHOR]

The Fezouata Biota (Morocco) is a Burgess Shale-type (BST) assemblage that provides a wealth of information on Early Ordovician ecosystems. Much work has been done to compare the preservation of the Fezouata Biota to other BSTs. However, studies investigating preservation variations within the Fezouata Biota are rare. Here, we use probabilities to investigate the preservation of various ecological categories of Fezouata eumetazoans. Complex taphonomic processes and phylum-specific constraints have led to the better preservation of predators/scavengers in this biota. However, no differences in preservation are observed between vagile and sessile taxa. Importantly, Tremadocian taxa are better preserved than Floian ones. As such, this study highlights the gradual closure of the BST window of preservation in the Zagora region of Morocco and constitutes a benchmark for future palaeoecological and evolutionary studies on the Fezouata Biota. [ABSTRACT FROM AUTHOR]

The complex jagged trajectory of fractured surfaces of two pieces of forensic evidence is used to recognize a "match" by using comparative microscopy and tactile pattern analysis. The material intrinsic properties and microstructures, as well as the exposure history of external forces on a fragment of forensic evidence have the premise of uniqueness at a relevant microscopic length scale (about 2–3 grains for cleavage fracture), wherein the statistics of the fracture surface become non-self-affine. We utilize these unique features to quantitatively describe the microscopic aspects of fracture surfaces for forensic comparisons, employing spectral analysis of the topography mapped by three-dimensional microscopy. Multivariate statistical learning tools are used to classify articles and result in near-perfect identification of a "match" and "non-match" among candidate forensic specimens. The framework has the potential for forensic application across a broad range of fractured materials and toolmarks, of diverse texture and mechanical properties. The complex jagged trajectory of fractured surfaces of two pieces of forensic evidence is used to recognize a match by using comparative microscopy. Here the authors leveraged statistical analysis of the surface topography to provide a quantitative description of the fracture surface, enabling forensic article comparisons with quantified probabilities. [ABSTRACT FROM AUTHOR]

Background: Various studies have shown that the type of intensity measure affects training intensity distribution (TID) computation. These conclusions arise from studies presenting data from meso- and macrocycles, while microcycles, e.g., high-intensity interval training shock microcycles (HIIT-SM) have been neglected so far. Previous literature has suggested that the time spent in the high-intensity zone, i.e., zone 3 (Z3) or the "red zone", during HIIT may be important to achieve improvements in endurance performance parameters. Therefore, this randomized controlled trial aimed to compare the TID based on running velocity (TIDV), running power (TIDP) and heart rate (TIDHR) during a 7-day HIIT-SM. Twenty-nine endurance-trained participant were allocated to a HIIT-SM consisting of 10 HIIT sessions without (HSM, n = 9) or with (HSM + LIT, n = 9) additional low-intensity training or a control group (n = 11). Moreover, we explored relationships between time spent in Z3 determined by running velocity (Z3V), running power (Z3P), heart rate (Z3HR), oxygen uptake ( Z 3 V ˙ O 2 ) and changes in endurance performance. Results: Both intervention groups revealed a polarized pattern for TIDV (HSM: Z1: 38 ± 17, Z2: 16 ± 17, Z3: 46 ± 2%; HSM + LIT: Z1: 59 ± 18, Z2: 14 ± 18, Z3: 27 ± 2%) and TIDP (Z1: 50 ± 8, Z2: 14 ± 11, Z3: 36 ± 7%; Z1: 62 ± 15, Z2: 12 ± 16, Z3: 26 ± 2%), while TIDHR (Z1: 48 ± 13, Z2: 26 ± 11, Z3: 26 ± 7%; Z1: 65 ± 17, Z2: 22 ± 18, Z3: 13 ± 4%) showed a pyramidal pattern. Time in Z3HR was significantly less compared to Z3V and Z3P in both intervention groups (all p < 0.01). There was a time x intensity measure interaction for time in Z3 across the 10 HIIT sessions for HSM + LIT (p < 0.001, pη2 = 0.30). Time in Z3V and Z3P within each single HIIT session remained stable over the training period for both intervention groups. Time in Z3HR declined in HSM from the first (47%) to the last (28%) session, which was more pronounced in HSM + LIT (45% to 16%). A moderate dose–response relationship was found for time in Z3V and changes in peak power output (rs = 0.52, p = 0.028) as well as time trial performance (rs = − 0.47, p = 0.049) with no such associations regarding time in Z3P, Z3HR, and Z 3 V ˙ O 2 . Conclusion: The present study reveals that the type of intensity measure strongly affects TID computation during a HIIT-SM. As heart rate tends to underestimate the intensity during HIIT-SM, heart rate-based training decisions should be made cautiously. In addition, time in Z3V was most closely associated with changes in endurance performance. Thus, for evaluating a HIIT-SM, we suggest integrating a comprehensive set of intensity measures. Trial Registration Trial register: Clinicaltrials.gov, registration number: NCT05067426. Key Points: Using heart rate, running velocity and running power as measures of intensity leads to different patterns of training intensity distribution during a 7-day HIIT shock microcycle. A polarized pattern was observed for velocity and power, whereas a more pyramidal distribution was found for heart rate. Additional low-intensity training volume during a HIIT shock microcycle led to a more pronounced decline in time in zone 3 measured with heart rate compared to a shock microcycle with HIIT sessions, only. A moderate dose–response relationship was observed between time in zone 3 measured by velocity and changes in peak power output as well as time-trial performance. No such correlation was found between time in zone 3 measured by power, heart rate, oxygen uptake, and changes in endurance performance parameters. [ABSTRACT FROM AUTHOR]

Understanding the evolving nature of coronary hemodynamics is crucial for early disease detection and monitoring progression. We require digital twins that mimic a patient's circulatory system by integrating continuous physiological data and computing hemodynamic patterns over months. Current models match clinical flow measurements but are limited to single heartbeats. To this end, we introduced the longitudinal hemodynamic mapping framework (LHMF), designed to tackle critical challenges: (1) computational intractability of explicit methods; (2) boundary conditions reflecting varying activity states; and (3) accessible computing resources for clinical translation. We show negligible error (0.0002–0.004%) between LHMF and explicit data of 750 heartbeats. We deployed LHMF across traditional and cloud-based platforms, demonstrating high-throughput simulations on heterogeneous systems. Additionally, we established LHMFC, where hemodynamically similar heartbeats are clustered to avoid redundant simulations, accurately reconstructing longitudinal hemodynamic maps (LHMs). This study captured 3D hemodynamics over 4.5 million heartbeats, paving the way for cardiovascular digital twins. [ABSTRACT FROM AUTHOR]

Background: Existing research indicates that the Mediterranean diet has a positive impact on preventing and treating hypertension. However, its specific effect on hypertension among elderly Chinese individuals is unclear. Aims: The objective of this research was to explore the association between the Chinese version of the Mediterranean-DASH Intervention for Neurodegenerative Delay (cMIND) diet and hypertension among elderly Chinese individuals, aiming to offer novel strategies for alleviating the burden of hypertension in this demographic. Methods: In this study, we used cross-sectional data published in 2018 by the China Longitudinal Health and Longevity Survey (CLHLS) to develop a binary logistic regression model to investigate the correlation between cMIND diet and hypertension in a Chinese elderly population. Restricted cubic spline was used to test for linear associations, and further subgroup analyses were performed to test for interactions. Results: In total, 7,103 older adults were included in the study, with a prevalence of hypertension of 39.0%. When the cMIND diet score was used as a continuous variable, a significant protective effect against hypertension was present (OR = 0.955, 95% CI:0.923–0.988, p = 0.008); when used as a categorical variable, this protective effect was still present at higher levels (compared to lower levels) of the cMIND diet (OR = 0.869, 95% CI: 0.760–0.995, p = 0.042). Discussion: Although the Mediterranean diet has great potential to reduce the chance of hypertension, it should also consider the effect on the Chinese population. The results of this study provide new ways to reduce the disease burden of hypertension in Chinese older adults and improve quality of life in later life. Conclusion: The cMIND diet can considerably reduce the risk of hypertension among older adults in China. [ABSTRACT FROM AUTHOR]

Objectives: Epidemiology showed that the falling incidences increased with advanced age, and recent findings found link between nutritional intake and risk of falls. Nevertheless, the relationship between different plant-based diets and the risk of falls in older adults remains unclear. Our investigation aimed to evaluate the correlation between various plant-based diet indices and the occurrence of falls. Design: This study is a cross-sectional and post-hoc analysis from a national cohort study. Setting and participants: We included individuals over 65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) recruited in 2018 with information on falls and dietary assessments, finally 11,044 participants were eligible. Measurements: Using food frequency questionnaire (FFQ), we calculated plant-based index scores categorized as unhealthy plant-based index (uPDI) and healthy plant-based index (hPDI). The primary outcome was falls obtained from questionnaire. Statistical analysis was performed utilizing logistic regression model to investigate the relationship between the plant-based diet indices and falls. We also used the subgroup analysis to investigate the interaction of falls and plant-based diet index (PDI) among different status and used the restricted cubic spline (RCS) curves to investigate the connection between the PDI scores and falls risk. Results: Among 11,044 participants included in our study, a total of 2493 fall cases were observed. The logistic regression analysis revealed that the plant-based index related to falls. In the adjusted model, per 10-unit increment of hPDI has a significant decreased risk of falls (odd ratio [OR]: 0.85, 95% confidence interval [CI]: 0.79–0.91, P for trend < 0.001) and per 10-unit increment in uPDI increased the risk of falls (OR: 1.21, 95% CI: 1.13–1.30, P for trend < 0.001). We also revealed an interaction between smoking status and falls among the uPDI group (Pinteraction = 0.012). Finally, we found that with plant-based index scores increased, the odds of falls among hPDI decreased (P for overall < 0.001, P nonlinear = 0.0239), and the odds of falls among uPDI increased (P for overall < 0.001, P nonlinear = 0.0332). Conclusion and implications: We found significant association between the Plant-based diet index and the risk of falls, highlighting the key role of the consumption of nutritious plant-based foods on the risk of falls, which needed take into account in developing intervention and prevention strategies to decrease falls among older Chinese adults. [ABSTRACT FROM AUTHOR]

Background: Severe trauma is the leading cause of disability and mortality in the patients under 35 years of age. Surgical site infections (SSI) represent a significant complication in this patient population. However, they are often inadequately investigated, potentially impacting the quality of patient outcomes. The aim of this study was to investigate the epidemiology of SSI and risk factors in severe trauma patients. Methods: We conducted a multicenter retrospective cohort study screening the severe trauma patients (STP) admitted to two intensive care units of an academic institution in Marseille between years2018 and 2019. Those who underwent orthopedic or spinal surgery within 5 days after admission were included and classified into two groups according to the occurrence of SSI (defined by the Centers for Disease Control (CDC) international diagnostic criteria) or not. Our secondary goal was to evaluate STP survival at 48 months, risk factors for SSI and microbiological features of SSI. Results: Forty-seven (23%) out of 207 STP developed an SSI. Mortality at 48-months did not differ between SSI and non-SSI patients (12.7% vs. 10.0%; p = 0.59). The fractures of 22 (47%) severe trauma patients with SSI were classified as Cauchoix 3 grade and 18 (38%) SSI were associated with the need for external fixators. Thirty (64%) severe trauma patients with SSI had polymicrobial infection, including 34 (72%) due to Gram-positive cocci. Empirical antibiotic therapy was effective in 31 (66%) cases. Multivariate analysis revealed that risk factors such as low hemoglobin, arterial oxygenation levels, hyperlactatemia, high serum creatinine and glycemia, and Cauchoix 3 grade on the day of surgery were associated with SSI in severe trauma patients. The generated predictive model showed a good prognosis performance with an AUC of 0.80 [0.73–0.88] and a high NPV of 95.9 [88.6–98.5] %. Conclusions: Our study found a high rate of SSI in severe trauma patients, although SSI was not associated with 48-month mortality. Several modifiable risk factors for SSI may be effectively managed through enhanced perioperative monitoring and the implementation of a patient blood management strategy. [ABSTRACT FROM AUTHOR]

Background: Bleeding in early pregnancy is a common emergency department (ED) presentation. Although variability in approaches has been demonstrated, research is relatively uncommon on practices and outcomes. This study investigated the influence of clinical pattern of care, utility, and contribution of pelvic examination aimed at diagnosing and managing bleeding in early pregnancy at three Canadian EDs. Methods: After obtaining informed consent, data were collected from adult women who were pregnant and from treating ED physicians using a structured questionnaire. We defined the change in management based on the initial clinical plan at the time of the initial physician assessment in the ED and any subsequent changes made after the pelvic examination was performed. Patient telephone follow-up was supplemented by linking with provincial administrative data for births. Univariable and multivariable binary logistic regression analyses were performed to identify factors associated with a change in patient management following pelvic examination in the ED. Results: Overall, 200 women were enrolled. The mean age was 31 years, patients had been bleeding for a median of 1 day and stayed in the ED for a median of 5 h. Of these, 166 (83.0%) received a pelvic examination, including speculum examination and/or bimanual palpation. Pregnancy outcome data were available for 192 pregnancies; 107 (56%) experienced a miscarriage. Factors significantly associated with a change in management after pelvic examination in the univariate logistic regression analysis were brown/dark-red bleeding per vaginam (physician determined), tachycardia, right lower quadrant tenderness, and bimanual palpation. In the multivariate logistic regression analysis, brown/dark-red bleeding per vaginam was independently associated with a reduced likelihood of a change in management after pelvic examination (aOR = 0.37; 95% CI: 0.14–0.98). Conclusion: Among women presenting to the ED with bleeding in early pregnancy prior to 20 weeks gestation, only brown/dark-red vaginal bleeding, potentially indicative of bleeding resolution, significantly independently influenced the baseline odds of a change in management after pelvic examination. Until the debate on the utility of pelvic examination in the ED for this presentation is resolved, physician preferences and shared decision making with patients should guide practice regarding speculum examination/bimanual palpation for the management of bleeding in early pregnancy. [ABSTRACT FROM AUTHOR]

The epidemic and outbreaks of influenza B Victoria lineage (Bv) during 2019–2022 led to an analysis of genetic, epitopes, charged amino acids and Bv outbreaks. Based on the National Influenza Surveillance Network (NISN), the Bv 72 strains isolated during 2019–2022 were selected by spatio-temporal sampling, then were sequenced. Using the Compare Means, Correlate and Cluster, the outbreak data were analyzed, including the single nucleotide variant (SNV), amino acid (AA), epitope, evolutionary rate (ER), Shannon entropy value (SV), charged amino acid and outbreak. With the emergence of COVID-19, the non-pharmaceutical interventions (NPIs) made Less distant transmission and only Bv outbreak. The 2021–2022 strains in the HA genes were located in the same subset, but were distinct from the 2019–2020 strains (P < 0.001). The codon G → A transition in nucleotide was in the highest ratio but the transversion of C → A and T → A made the most significant contribution to the outbreaks, while the increase in amino acid mutations characterized by polar, acidic and basic signatures played a key role in the Bv epidemic in 2021–2022. Both ER and SV were positively correlated in HA genes (R = 0.690) and NA genes (R = 0.711), respectively, however, the number of mutations in the HA genes was 1.59 times higher than that of the NA gene (2.15/1.36) from the beginning of 2020 to 2022. The positively selective sites 174, 199, 214 and 563 in HA genes and the sites 73 and 384 in NA genes were evolutionarily selected in the 2021–2022 influenza outbreaks. Overall, the prevalent factors related to 2021–2022 influenza outbreaks included epidemic timing, Tv, Ts, Tv/Ts, P137 (B → P), P148 (B → P), P199 (P → A), P212 (P → A), P214 (H → P) and P563 (B → P). The preference of amino acid mutations for charge/pH could influence the epidemic/outbreak trends of infectious diseases. Here was a good model of the evolution of infectious disease pathogens. This study, on account of further exploration of virology, genetics, bioinformatics and outbreak information, might facilitate further understanding of their deep interaction mechanisms in the spread of infectious diseases. [ABSTRACT FROM AUTHOR]

Background: Strength training (ST) primarily enhances physical fitness (e.g., muscle strength, power, speed) and bone density in female soccer players. Less information is available on the injury preventive effects of ST in female athletes. Accordingly, this study aimed to investigate the effects of a 12-week in-season ST on measures of physical fitness and injury occurrence in young elite female soccer players. Methods: Thirty elite female soccer players (15.4 ± 1.9 years; maturity offset + 2.3 ± 1.1 years) participated in this study, and were randomly assigned to a strength training group (STG, n = 14) or an active control (CG, n = 16) group. ST lasted twelve weeks and included full body muscle strengthening exercises using primarily weight machines at progressive intensities ranging between 40 and 85% of the one-repetition-maximum (1-RM). The CG practiced a traditional soccer training program. Overall, training volumes of the two groups were similar with a training load (rating of perceived exertion × time) of 1158.4 ± 67.7 arbitrary unity (AU) for the STG and 1188.8 ± 44.1 AU for the CG. Pre and post training, the following physical fitness tests were applied: dynamic muscle strength (relative [to body mass] and absolute 1-RM bench/leg press, lat-pull down), jump performance (countermovement jump [CMJ], squat jump [SJ], five-jump-test [5JT]), linear-sprint speed (5-m, 10-m, 30-m), change-of-direction speed (T-test with and without ball), sport-specific performance (Yo-Yo Intermittent Level1 [YYIRTL1], and repeated shuttle sprint ability [RSSA]). The injury rate per 1000-h exposure was monitored throughout the soccer season. Results: No significant baseline differences were observed between groups. Statistically significant group-by-time interactions were found for absolute (p < 0.001, d = 2.59) and relative 1-RM bench press (p < 0.001, d = 2.39), absolute 1-RM lat-pull down (p < 0.001, d = 1.68), and relative 1-RM leg press (p < 0.001, d = 1.72). Significant group-by-time interactions were observed for CMJ (p = 0.005, d = 1.27), RSSAmean (p = 0.007, d = 0.81), and RSSAtotal (p < 0.001, d = 1.90). Post-hoc tests indicated that the STG group demonstrated greater improvements in all tested variables compared to CG (1.2 < d < 2.5). However, no significant interaction effects were noted for measures of linear sprint speed and YYIRTL1 performance. Additionally, non-contact injuries during the season were significantly lower (p = 0.003, d = 1.31) in the STG (0.48/1000 h of exposure) than the CG (2.62/1000 h of exposure). Conclusions: Twelve weeks of an in-season ST resulted in larger physical fitness improvements and fewer injuries compared with an active control in elite young female soccer players. Accordingly, ST should be systematically applied in female soccer to enhance performance and prevent injuries. Key Finding: This study showed that the incorporation of 12 weeks of strength training with two weekly sessions during the soccer season improves anthropometric and body composition characteristics as well as measures of physical fitness in adolescent elite female soccer players. Strength training reduces the incidence of non-contact injuries in young female soccer players. The usage of strength training machines is safe in elite young female soccer players with no previous experience in weightlifting. [ABSTRACT FROM AUTHOR]

Background and Aims: Drainage of pancreatic fluid collections (PFCs) is required in select cases including infected or symptomatic collections. In this network meta-analysis, we have compared lumen-apposing metal stents (LAMS), fully covered self-expandable metal stents (FCSEMS), and double-pigtail stents (DPS) to identify the most useful stent type in the management of PFCs. Methods: We reviewed several databases to identify studies that compared DPS or FCSEMS with LAMS and the ones which compared DPS with FCSEMS for the treatment of PFCs. Our outcomes of interest were clinical success, adverse events, technical success, recurrence of PFCs, and procedure duration. Random effects model and frequentist approach were used for statistical analysis. Results: We included 28 studies with 2974 patients. Rate of clinical success was significantly lower with DPS compared to LAMS, OR (95% CI): 0.43 (0.32, 0.59). Rate of recurrence was higher with DPS compared to LAMS, OR (95% CI): 2.06 (1.19, 3.57). We found no significant difference in rate of adverse events between groups. Rate of technical success was higher for FCSEMS compared to LAMS. Procedure duration was significantly shorter for LAMS compared to DPS and FCSEMS. Based on frequentist approach, LAMS was found to be superior to DPS and FCSEMS in achieving higher clinical success, lower rate of adverse events and recurrence, and shorter procedure time. Conclusions: This network meta-analysis demonstrates the superiority of LAMS over DPS and FCSEMS in the management of PFCs in achieving a higher clinical success, shorter procedure time, and lower rate of recurrence. Some of the analyses are not adequately powered to make firm conclusions, and future large multicenter RCTs are required to further evaluate this issue. [ABSTRACT FROM AUTHOR]

Forecasting phenological events has important uses in warm Mediterranean area, where olive is one of the oldest cultivated species.Thus, continuously-recorded phenological observations for the main olive cultivar Chemlali widely spreading in warm and sub-arid area were achieved during 2005–2019 in central Tunisia. Gathered climatic and phenological data were used to: i) delineate the chill and heat accumulation periods and the thermal requirements using Partial Least Squares (PLS) approach; and to ii) develop statistical models predicting budburst and flowering dates. Results revealed significant yearly variations in budburst and flowering dates related to the climatic conditions. PLS analysis delineated two chill accumulation periods spanned from November 19th to January 12th and from the end of March to the beginning of April, respectively. Stepwise regression revealed that the best indicator of the budburst date was the mean temperature in pentad-6 of November followed by the minimum and the mean temperature during pentad-2 of February. Based on these two statistical analyses, chilling requirements seemed to be linked to the first delineated chill accumulation period. Average chilling and heat requirements of 'Chemlali' olive cultivar were 17 CP and 24892 GDH, respectively. A forecasting linear model was generated displaying mean absolute error of 1.6 and 2.4 days between simulated and observed budburst and start flowering dates, respectively. These proposed models will be very helpful for orchard management and the high number of independent factors determining the critical periods necessary for flowering may explain the adaptive plasticity of 'Chemlali' cultivar growing in sub-arid and warm areas. [ABSTRACT FROM AUTHOR]

Introduction: Older adults face a higher risk of vancomycin-related toxicity given their (patho)-physiological changes, making early management of supratherapeutic exposure crucial. Yet, data on vancomycin exposure in older adults is scarce. This study aims to compare vancomycin concentrations between older and younger patients, emphasizing supratherapeutic concentrations and the effect of patient characteristics. Methods: This observational retrospective study was conducted in the University Hospital of Leuven (EC Research S65213). We analyzed early (first) vancomycin concentrations between older (≥ 75 years) and younger patients. Multivariable analyses were conducted to evaluate the association between baseline patient characteristics with supratherapeutic exposure (logistic regression), and dose-normalized concentrations (linear regression). Results: We included 449 patients aged ≥ 75 years (median 80) and 1609 aged < 75 years (median 61). In univariable analysis, the first-measured vancomycin concentrations were significantly higher in older adults (p < 0.001), who more frequently reached supratherapeutic concentrations (30.7% versus 21%; p < 0.001). In multivariable analysis, factors associated with supratherapeutic concentrations were decreased the estimated glomerular filtration rate calculated by using the Chronic Kidney Disease Epidemiology Collaboration equation (eGFRCKD-EPI) [odds ratio (OR) of 0.98, confidence interval (CI) 0.97–0.98]. Supratherapeutic concentrations had inverse association with giving lower loading dose (OR of 0.59, CI 0.39–0.90), and lower maintenance dose (OR of 0.45, CI 0.26–0.77). Factors that predicted increased dose-normalized concentrations included decreased eGFRCKD-EPI (coefficient of −0.05, CI −0.06 to −0.04), lower body weight (coefficient of −0.04, CI −0.05 to −0.03), increased blood urea nitrogen (coefficient of 0.02, CI 0.01–0.03), and delayed time to therapeutic drug monitoring (TDM) sampling (coefficient of 0.08, CI 0.06–0.09). Conclusions: The absence of age as a significant factor in the multivariable analysis suggests that eGFRCKD-EPI mediated the relationship between age and vancomycin exposure. Older adults may benefit more from vancomycin TDM. [ABSTRACT FROM AUTHOR]

Without writing a single line of code by a human, an example Monte Carlo simulation-based application for stochastic dependence modeling with copulas is developed through pair programming involving a human partner and a large language model (LLM) fine-tuned for conversations. This process encompasses interacting with ChatGPT using both natural language and mathematical formalism. Under the careful supervision of a human expert, this interaction facilitated the creation of functioning code in MATLAB, Python, and R. The code performs a variety of tasks including sampling from a given copula model, evaluating the model's density, conducting maximum likelihood estimation, optimizing for parallel computing on CPUs and GPUs, and visualizing the computed results. In contrast to other emerging studies that assess the accuracy of LLMs like ChatGPT on tasks from a selected area, this work rather investigates ways how to achieve a successful solution of a standard statistical task in a collaboration of a human expert and artificial intelligence (AI). Particularly, through careful prompt engineering, we separate successful solutions generated by ChatGPT from unsuccessful ones, resulting in a comprehensive list of related pros and cons. It is demonstrated that if the typical pitfalls are avoided, we can substantially benefit from collaborating with an AI partner. For example, we show that if ChatGPT is not able to provide a correct solution due to a lack of or incorrect knowledge, the human-expert can feed it with the correct knowledge, e.g., in the form of mathematical theorems and formulas, and make it to apply the gained knowledge in order to provide a correct solution. Such ability presents an attractive opportunity to achieve a programmed solution even for users with rather limited knowledge of programming techniques. [ABSTRACT FROM AUTHOR]

Spherical data arise widely in various settings. Spherical statistics is an analysis of data on a unit hyper-spherical domain. In this paper, we mainly consider the local kernel estimators for regression models with a binary response and the predictors including spherical variables. We apply the random forests kernel to nonparametric binary regression models with spherical predictors. Simulation experiments and real examples are used to validate the performance of the new models. Compared with the classical von Mises–Fisher kernel and the linear-spherical kernel, the random forests kernel has better fitting effect and faster computation speed. Compared with other classifiers, the models proposed in this paper have better classification performance in both low and high dimensional cases. [ABSTRACT FROM AUTHOR]

Objectives: Current policies for older patients do not adequately address the barriers to effective implementation of optimal care models in New Zealand, partly due to differences in patient definitions and the in-patient pathway they should follow through hospital. This research aims to: (a) synthesise a definition of a complex older patient; (b) identify and explore primary and secondary health measures; and (c) identify the primary components of a care model suitable for a tertiary hospital in the midland region of the North Island of New Zealand. Method: This mixed-methods study utilised a convergence model, in which qualitative and quantitative data were investigated separately and then combined for interpretation. Semi-structured interviews (n=11) were analysed using a general inductive method of enquiry to develop key codes, categories and themes. Univariate data analysis was employed using six years of routinely collected data of patients admitted to the emergency department and inpatient units (n=261,773) of the tertiary hospital. Results: A definition of a complex older patient was determined that incorporates chronic conditions, comorbidities and iatrogenic complications, functional decline, activities of daily living, case fatality, mortality, hospital length of stay, hospital costs, discharge destination, hospital readmission and emergency department revisit and age – not necessarily over 65 years old. Well-performing geriatric care models were found to include patient-centred care, frequent medical review, early rehabilitation, early discharge planning, a prepared environment and multidisciplinary teams. Conclusions: The findings of this New Zealand study increase understanding of acute geriatric care for complex older patients by filling a gap in policies and strategies, identifying potential components of an optimal care model and defining a complex geriatric patient. Implications for Public Health: The findings of this study present actionable opportunities for clinicians, managers, academics and policymakers to better understand a complex older patient in New Zealand, with significant relevance also for international geriatric care and to establish an effective acute geriatric care model that leads to beneficial health outcomes and provides safeguard mechanisms. [ABSTRACT FROM AUTHOR]

Purpose: Dietary nitrate (NO3−) supplementation enhances muscle blood flow and metabolic efficiency in hypoxia, however, its efficacy on neuromuscular function and specifically, the effect on motor unit (MU) activity is less clear. We investigated whether NO3− supplementation affected MU activity following a 3 min sustained ischemic contraction and whether this is influenced by blood flow restriction (BFR) during the recovery period. Method: In a randomized, double-blinded, cross-over design, 14 males (mean ± SD, 25 ± 6 years) completed two trials following 5 days of supplementation with NO3−-rich (NIT) or NO3−-depleted (PLA) beetroot juice to modify plasma nitrite (NO2−) concentration (482 ± 92 vs. 198 ± 48 nmol·L−1, p < 0.001). Intramuscular electromyography was used to assess MU potential (MUP) size (duration and area) and mean firing rates (MUFR) during a 3 min submaximal (25% MVC) isometric contraction with BFR. These variables were also assessed during a 90 s recovery period with the first half completed with, and the second half completed without, BFR. Results: The change in MUP area and MUFR, did not differ between conditions (all p > 0.05), but NIT elicited a reduction in MUP recovery time during brief isometric contractions (p < 0.001), and during recoveries with (p = 0.002) and without (p = 0.012) BFR. Conclusion: These novel observations improve understanding of the effects of NO3− on the recovery of neuromuscular function post-exercise and might have implications for recovery of muscle contractile function. Trial registration: The study was registered on clinicaltrials.gov with ID of NCT05993715 on August 08, 2023. [ABSTRACT FROM AUTHOR]

Purpose: Obesity is a primary risk factor for knee osteoarthritis (OA). Prebiotics enhance beneficial gut microbes and can reduce body fat and inflammation. Our objective was to examine if a 6-month prebiotic intervention improved physical function in adults with knee osteoarthritis and obesity. We also measured knee pain, body composition, quality of life, gut microbiota, inflammatory markers, and serum metabolomics. Methods: Adults (n = 54, mostly women) with co-morbid obesity (BMI > 30 kg/m2) and unilateral/bilateral knee OA were randomly assigned to prebiotic (oligofructose-enriched inulin; 16 g/day; n = 31) or isocaloric placebo (maltodextrin; n = 21) for 6 months. Performance based-tests, knee pain, quality of life, serum metabolomics and inflammatory markers, and fecal microbiota and short-chain fatty acids were assessed. Results: Significant between group differences were detected for the change in timed-up-and-go test, 40 m fast paced walk test, and hand grip strength test from baseline that favored prebiotic over placebo. Prebiotic also reduced trunk fat mass (kg) at 6 months and trunk fat (%) at 3 months compared to placebo. There was a trend (p = 0.059) for reduced knee pain at 6 months with prebiotic versus placebo. In gut microbiota analysis, a total of 37 amplicon sequence variants differed between groups. Bifidobacterium abundance was positively correlated with distance walked in the 6-min walk test and hand grip strength. At 6 months, there was a significant separation of serum metabolites between groups with upregulation of phenylalanine and tyrosine metabolism with prebiotic. Conclusion: Prebiotics may hold promise for conservative management of knee osteoarthritis in adults with obesity and larger trials are warranted. Clinical Trial Registration: Clinicaltrials.gov/study/NCT04172688. [ABSTRACT FROM AUTHOR]

Purpose: Front-of-pack labelling systems, such as the Health Star Rating (HSR), aim to aid healthy consumer dietary choices and complement national dietary guidelines. Dietary guidelines aim to be holistic by extending beyond the individual nutrients of food, including other food components that indicate diet quality, including whole grains. We aimed to test the feasibility of including whole grains in the HSR algorithm, to better inform dietary guidance in Australia coherent with existing dietary guidelines. Methods: We assigned whole-grain points as a favourable component of the HSR based on the whole-grain content of foods. We compared the original, and three modified HSR algorithms (including altered thresholds for star ratings) using independent-samples median tests. Finally, we used Spearman's correlation to measure the strength of association between an item's nutritional composition (all components of the HSR algorithm including all favourable and unfavourable components) and their HSR using each algorithm. Results: Up to 10 points were added for products with ≥ 50% whole-grain content, with no points for products with < 25%. Adjusting the HSR score cut-off by 3 points for grain products created the greatest difference in median HSR between refined and whole-grain items (up to 2 stars difference), compared to the original algorithm (a maximum of 1 star). Conclusions: The addition of whole grains to the HSR algorithm improved the differentiation of refined and whole-grain items, and therefore better aligned with dietary guidelines. Holistic approaches to food guidance systems are required to provide consistent messaging and inform positive food choices. [ABSTRACT FROM AUTHOR]

Purpose: Short-term intake of the egg-protein hydrolysate Newtricious (NWT)-03 improved executive function, but underlying mechanisms and long-term effects, including other cognitive domains, are unknown. Methods: A 36-week randomized controlled trial involving 44 overweight/obese individuals experiencing elevated Subjective Cognitive Failures (SCF; aged 60–75 years) assessed the impact of daily consumption of 5.7 g of NWT-03 or placebo powders on cognitive performance (psychomotor speed, executive function, memory) and Cerebral Blood Flow (CBF), a marker of brain vascular function. Cognitive performance was evaluated using a neurophysiological test battery (CANTAB) and CBF was measured using magnetic resonance imaging perfusion method Arterial Spin Labeling (ASL). Serum samples were collected to determine brain-derived neurotrophic factor (BDNF) concentrations. Results: Anthropometrics, and energy and nutrient intakes remained stable throughout the trial. NWT-03 was well tolerated, and compliance was excellent (median: 99%; range: 87–103%). No overall intervention effects were observed on cognitive performance or CBF, but post-hoc analyses revealed significant improvements on executive function in women, but not men. Specifically, a reduction of 74 ms in reaction latency on the multitasking task (95% CI: −134 to −15; p = 0.02), a reduction of 9 between errors (95%CI: −14 to −3; p < 0.001), and a reduction of 9 total errors (95%CI: −15 to −3; p < 0.001) on the spatial working memory task were found in women. No intervention effects were observed on serum BDNF concentrations (p = 0.31). Conclusion: Long-term consumption of NWT-03 improved multitasking abilities and working memory in women with elevated SCF. Brain vascular function remained unaffected. Sex differences in executive function require additional clarification. [ABSTRACT FROM AUTHOR]

Total least squares (TLS), also named as errors in variables in statistical analysis, is an effective method for solving linear equations with the situations, when noise is not just in observation data but also in mapping operations. Besides, the Tikhonov regularization is widely considered in plenty of ill-posed problems. Moreover, the structure of mapping operator plays a crucial role in solving the TLS problem. Tensor operators have some advantages over the characterization of models, which requires us to build the corresponding theory on the tensor TLS. This paper proposes tensor regularized TLS and structured tensor TLS methods for solving ill-conditioned and structured tensor equations, respectively, adopting a tensor-tensor-product. Properties and algorithms for the solution of these approaches are also presented and proved. Based on this method, some applications in image and video deblurring are explored. Numerical examples illustrate the effectiveness of our methods, compared with some existing methods. [ABSTRACT FROM AUTHOR]

Understanding the relation between the microstructure and the material's effective behavior is an important aspect in inverse computational materials engineering. Especially in the context of localized, inelastic phenomena like plasticity and crack growth, the microstructure morphology plays a crucial role. Due to the stochastic nature of heterogeneous media, a statistical analysis over multiple simulations is necessary, since even with the same material, the simulated crack paths and effective crack lengths are highly dependent on the specific locations of microstructural features. A relevant factor that limits this type of investigation is the high cost of real microstructure data. This work presents a digital workflow for exploring the fracture properties of materials. Therein, the required statistical analyses are facilitated by an algorithm that reconstructs multiple realization of a material structure given a single example. The reconstructed structures are discretized with a regular non-conforming mesh with a diffuse interface and crack representation. Crack phase-field simulations are conducted in order to analyze the effective response. An in-depth introduction to the required methods is given together with a statistical evaluation of the conducted numerical experiments. It is concluded that the statistical variation of the effective material behavior overshadows morphological trends in the presented case. This confirms the relevance and utility of complementing simulation-based workflows with microstructure reconstruction and statistical analyses. [ABSTRACT FROM AUTHOR]

Co-twin studies are an elegant and powerful design that allows controlling for the effect of confounding variables, including genetic and a range of environmental factors. There are several approaches to carry out this design. One of the methods commonly used, when contrasting continuous variables, is to calculate difference scores between members of a twin pair on two associated variables, in order to analyse the covariation of such differences. However, information regarding whether and how the different ways of estimating within-pair difference scores may impact the results is scant. This study aimed to compare the results obtained by different methods of data transformation when performing a co-twin study and test how the magnitude of the association changes using each of those approaches. Data was simulated using a direction of causation model and by fixing the effect size of causal path to low, medium, and high values. Within-pair difference scores were calculated as relative scores for diverse within-pair ordering conditions or absolute scores. Pearson's correlations using relative difference scores vary across the established scenarios (how twins were ordered within pairs) and these discrepancies become larger as the within-twin correlation increases. Absolute difference scores tended to produce the lowest correlation in every condition. Our results show that both using absolute difference scores or ordering twins within pairs, may produce an artificial decrease in the magnitude of the studied association, obscuring the ability to detect patterns compatible with causation, which could lead to discrepancies across studies and erroneous conclusions. [ABSTRACT FROM AUTHOR]

Various popular multiplayer battle royale games share a lot of common elements. Drawing from our observations, we summarized these shared characteristics and subsequently proposed a novel heuristic algorithm named multiplayer battle game-inspired optimizer (MBGO). The proposed MBGO streamlines mainstream multiplayer battle royale games into two discrete phases: movement and battle. Specifically, the movement phase incorporates the principles of commonly encountered "safe zones" to incentivize participants to relocate to areas with a higher survival potential. The battle phase simulates a range of strategies players adopt in various situations to enhance the diversity of the population. To evaluate and analyze the performance of the proposed MBGO, we executed it alongside ten other algorithms, including three classics and five latest ones, across multiple diverse dimensions within the CEC2017 and CEC2020 benchmark functions. In addition, we employed several industrial design problems to evaluate the scalability and practicality of the proposed MBGO. The statistical analysis results reveal that the novel MBGO demonstrates significant competitiveness, excelling in convergence speed and achieving high levels of convergence accuracy across both benchmark functions and real-world problems. [ABSTRACT FROM AUTHOR]

Friendship racial homophily, the tendency to form friendships with individuals who share the same racial background, is a normative developmental phenomenon that holds particular significance for youth of color in a racialized society. Yet, there exists a paucity of longitudinal research elucidating the stability and change of friendship racial composition across developmental span. This study aimed to examine the friendship racial homophily trajectories over a six-year period encompassing four time points. The sample comprised 437 Asian American youth (MAge = 16.52, SDAge = 1.36, 53% female), with 197 Filipino and 240 Korean participants. Using logistic multilevel modeling analyses, it was found that both Filipino and Korean American youth demonstrated an increase in friendship racial homophily from high school to college, but that Filipino youth overall reported lower levels of racial homophily compared to their Korean counterparts. The study findings also pinpointed several influential factors impacting these trajectories, including proficiency in heritage languages, ethnic identity, and encounters with racial discrimination from both White Americans and other People of Color. These results highlight the continuous evolution of friendship racial composition from high school to college and emphasize the crucial role of ethnic identity and experiences of discrimination in influencing these dynamics, with ethnic identity exerting more enduring effects and experiences of discrimination showing more situational impacts on the levels of racial homophily. [ABSTRACT FROM AUTHOR]

Although family and school experiences play an important role in adolescents' adjustment during the transition to high school, most prior studies investigated the effects of these experiences in isolation; their joint implications for both adolescents' concurrent and long-term adjustment outcomes are less clear, and the potential role of individual characteristics within such associations remains understudied. Based on 525 10th graders (Mage = 15.48, SDage = 0.71, 43.6% boys) who participated in a longitudinal study, the present research aimed to identify distinct family and school experience profiles among first-year high school students and examine their associations with adolescents' internalizing problems and externalizing problems, both concurrently and 18 months later. Latent profile analysis revealed four distinctive profiles: thriving, low resources—moderate family risk, developmental stress—high parental conflicts, and developmental stress—high peer victimization profiles. The other three profiles (vs. the thriving profile) reported significantly higher levels of concurrent internalizing problems; while these differences diminished after 18 months. However, the enduring impacts of these profiles on internalizing problems persisted among adolescents with higher levels of environmental sensitivity. Additionally, adolescents characterized by two developmental stress profiles (vs. the thriving profile) exhibited significantly higher levels of externalizing problems both currently and longitudinally. Findings underscore the importance of identifying at-risk populations among adolescents during the transition to high school by including both family and school experiences when examining environmental influence on their adjustment, as well as the necessity to take individual environmental sensitivity into account when examining these associations. [ABSTRACT FROM AUTHOR]

Late emerging adulthood is pivotal for identity exploration and development and is interrelated with life satisfaction. In the development of identity and life satisfaction, it is important to have a stable employment status that supports the foundation of life. However, the interrelationships among identity, life satisfaction, and employment status in late emerging adulthood are unclear. Using a two-wave longitudinal survey, this study examined identity development and whether the relationship between identity and life satisfaction varies by employment status. Participants included 875 Japanese emerging adults (65.5% women, Mage = 24.74, SDage = 0.44). Multivariate analysis of variance showed that identity synthesis decreased for those who lost their jobs or those who changed from being full-time to part-time employment. Additionally, individuals with full-time employment had higher identity synthesis and lower confusion than those with part-time or no employment. Multi-group path analysis indicated that identity synthesis was positively associated with life satisfaction and confusion was negatively associated, and these relationships did not differ by employment status. These findings suggest that identity development in late emerging adulthood varies by employment status and that the association between identity and life satisfaction may not be moderated by employment status. Overall, this study contributes to elucidating the characteristics of identity development along employment status and its relationship to life satisfaction in late emerging adulthood. [ABSTRACT FROM AUTHOR]

The tensor equation A x m - 1 = b with the tensor A of order m and dimension n and the vector b , has practical applications in several fields including signal processing, high-dimensional PDEs, high-order statistics, and so on. In this paper, a class of exponential accelerated iterative methods is proposed for solving the tensor equation mentioned above in the sense that the coefficient tensor A is a symmetric and nonsingular or singular M -tensor. The obtained iterative schemes involve the classical Newton's method as a special case. It is shown that the proposed method for nonsingular case is superlinearly convergent, while for singular cases, it is linearly convergent. The performed numerical experiments demonstrate that our methods outperform some existing ones. [ABSTRACT FROM AUTHOR]

Purpose: The Program for the Education and Enrichment of Relational Skills (PEERS®) is a group-based social skills training program for adolescents on the autism spectrum. Although the program has been shown to be effective in improving social skills in autistic adolescents, evidence of its effectiveness from the Mandarin-speaking Chinese population is sparse. The present study used a non-randomized, pre- and post-intervention research design to investigate the feasibility and cultural validity of the program, as well as examine the moderators of intervention outcomes. Methods: Thirty-three autistic adolescents with intelligence quotient above 70 (Mage = 13.57, SDage = 1.43; Male: Female 25:8) and their parents received 14 concurrent 90-minute sessions. Adolescents' autistic traits, challenging behaviors, emotional functioning, socio-cognitive process, social environment factors (school support), and caregivers' well-being were evaluated. Results: The findings suggest that with minor adjustments, the Mandarin version of PEERS® was generally acceptable and feasible for autistic adolescents and their parents. PEERS® may improve the social skills knowledge, reciprocal communication abilities, and emotional well-being of autistic adolescents. Also, participants with a higher level of school support, and parents with lower perceived subjective well-being at baseline may gain more benefits from PEERS®. The cultural adaptation and acceptability of the Mandarin Version of PEERS® were discussed. Conclusion: This feasibility study (Chinese Clinical Trial Registry: ChiCTR2200061417, 2022-06-23, retrospectively registered) provides a basis for further randomized control trials of the Mandarin version of PEERS®. [ABSTRACT FROM AUTHOR]

Though there is evidence autism identification has been inequitable for populations who are culturally and linguistically minoritized, there is limited research that explains the issue of disproportionality and factors contributing to its occurrence, especially within an educational setting. To explore contributors to racial/ethnic disparities in autism special education eligibility, the current investigation evaluated child and evaluation characteristics as they relate to the absence of autism eligibility. Data were obtained from the Autism and Developmental Disabilities Monitoring (ADDM) Network Study and included children with behavioral characteristics consistent with autism and educational evaluation records. Despite documented characteristics consistent with autism, only 72% of the sample received educational services under autism eligibility. To characterize children without autism eligibility, hierarchical logistic regression was used to evaluate factors documented in evaluation records predicting the absence of autism eligibility. Factors influencing autism eligibility included behavioral characteristics documented, evaluation components completed, intellectual ability, and clinical diagnoses present. There was no unique contribution of race/ethnicity in predicting the absence of autism eligibility when accounting for these previous predictors, but many of these predictors differed by racial/ethnic group. Disproportionality in autism may be the manifestation of inequitable evaluation experiences, including experiencing less comprehensive evaluations, and not receiving an autism specific assessment. Though race/ethnicity did not uniquely contribute to the absence of autism eligibility above and beyond those combined factors, it is important to evaluate and reduce inequities experienced within the autism identification process for populations who are culturally and linguistically minoritized. [ABSTRACT FROM AUTHOR]

The aim was to test the use of eye-tracking methodology for the early detection of ASD in a task of association between unfamiliar objects and pseudowords. Significant differences were found between ASD (n = 57) and TD (n = 57) Spanish speaking toddlers in the number and time of fixation. The TD children showed more and longer fixations on eyes and mouth while the ASD children attended almost exclusively to objects, making it difficult to integrate lexical and phonological information. Moreover, the TD toddlers looked at the mouth when the pseudoword was produced while the ASD toddlers did not. Gaze fixation on eyes and mouth during word learning recorded by eye-tracking may be used as a biomarker for the early diagnosis of ASD. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) symptoms affect 40–60% of autistic children and have been linked to differences in adaptive behavior. It is unclear whether adaptive behavior in autistic youth is directly impacted by co-occurring ADHD symptoms or by another associated feature of both autism and ADHD, such as increased irritability. The current study examined relationships between irritability, ADHD symptoms, and adaptive behavior in 3- to 7-year-old autistic children. Results suggest that, after adjusting for co-occurring ADHD symptoms, higher levels of irritability are associated with differences in social adaptive behavior specifically. Understanding relationships between irritability, ADHD, and adaptive behavior in autistic children is critical because measures of adaptive behavior, such as the Vineland Scales of Adaptive Functioning, are often used as a proxy for global functioning, as well as for developing intervention plans and measuring outcomes as primary endpoints in clinical trials. [ABSTRACT FROM AUTHOR]

Most data-driven landslide-susceptibility assessment models heavily rely on statistical analyses based on geological and environmental similarity principles. These models often struggle to establish connections with landslide destruction processes and mechanisms effectively. In response to this challenge, this study introduces a hybrid approach that combines the transient rainfall infiltration, regional slope-stability physics–based model (TRIGRS) and the random forest (RF) model. Initially, to calculate the safety coefficients of the study area, the TRIGRS model was employed, and appropriate non-landslide samples were selected based on these coefficients. Subsequently, to enable learning and fitting of the nonlinear relationships between sample points and geological environmental factors, historical landslide data and safety coefficient-filtered non-landslide point data were input into the RF model, ultimately generating landslide probability values that represent the magnitude of landslide occurrences. The coupled model demonstrated excellent predictive performance using the landslides induced by the 2019 "Lekima" typhoon in Yongjia, Zhejiang Province, as a case study. The results indicated that the evaluation effect of the TRIGRS and RF coupled model was satisfactory, achieving an accuracy (ACC) rate of 77.6% and an area under the curve (AUC) of 0.873. Furthermore, the ACC and AUC of the TRIGRS and RF coupled model increased by 8.22% and 9.20%, respectively, compared with those of the traditional buffering sampling method. Therefore, the TRIGRS and RF coupled model better evaluates regional landslide susceptibility than the traditional buffering sampling method. [ABSTRACT FROM AUTHOR]

Dam failure may lead to significant casualties among downstream residents. Therefore, it is crucial to study a reliable method to quantitatively assess the loss of life (LOL) caused by dam failure for emergency response to dam failure incidents. Based on a statistical analysis of typical dam failure accidents in China and the research on the formation mechanism of LOL, the study quantified the factors influencing LOL using fuzzy theory and constructed a quantitative database for the LOL. Then, it proposed an innovative algorithm integrating the grey wolf optimization (GWO) algorithm and the random forest (RF) model. Finally, a data-driven assessment model for the LOL caused by dam failure was developed by combining the gray correlation analysis of the factors. The performance of the GWO-RF model was validated using a dataset of the LOL caused. The proposed model was used to assess the LOL in typical dam failure events. The results indicate that the model has higher accuracy, with an average absolute error of approximately 945 persons, significantly lower than 2529 persons in the Graham method. Thus, it can effectively estimate the LOL caused by dam failure. This study developed a novel method for quantitatively assessing the LOL caused by dam failure, which could also serve as a reference for modeling disaster consequences in other fields. [ABSTRACT FROM AUTHOR]