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The present study focuses on an experimental investigation aiming at simultaneously optimizing tensile strength and elastic modulus of 3D-printed polymethyl methacrylate (PMMA) filament material while considering raster angle, printing speed, and layer thickness as the independent process-related control parameters. The Box-Behnken design of experiments (BBD) was applied to design the necessary number of experiments and establish the experimental design for fabricating experimental dog-bone samples of standard geometry. Further on, second-order regression models for tensile strength and elastic modulus were generated and employed to predict the three independent structural parameters and maximize tensile strength and elastic modulus. A neural network model was examined for its efficiency in terms of predicting the two responses. Results show a high correlation between inputs and outputs, enabling reliable modeling towards the objective of optimizing both the strength and elasticity of PMMA-fabricated parts. Regression models exhibited high correlation (R2) equal to 97.81% and 97.26% for tensile strength and elastic modulus, respectively. Simulation results referring to the neural network suggest a high correlation between outputs and targets during training (R = 0.9762), validation (R = 0.9974), and testing (R = 0.9808). [ABSTRACT FROM AUTHOR]

Background: Watching pimple-popping videos has become very popular, particularly on social media. However, the psychological mechanisms behind this novel and puzzling phenomenon remain largely unexplored. Two studies were conducted on this topic. A first study explored the validity of the Pimple Popping Enjoyment Scale (PPES) in terms of predicting viewing behavior during exposure to pimple-popping videos. A second study investigated the association between the PPES and other personality scales. Method: In Study 1, 104 participants (mean age = 26 years, 64% female) completed the PPES and watched pimple-popping videos with the option to skip forward and backward during viewing. In Study 2, 501 participants (mean age = 25 years, 79% female) answered the PPES and additional personality scales (e.g., benign masochism (BM), morbid curiosity (MC)). Results: Higher scores on the PPES were linked to fewer instances of skipping forward while watching pimple-popping videos, indicating reduced visual avoidance. Hierarchical regression analyses revealed that MC and BM were positively associated with PPES scores. Conclusions: The present findings help to understand a social media trend: why people watch and enjoy pimple-popping videos. This behavior is likely motivated by an interest in danger and potential death (MC) and the enjoyment derived from discomfort in non-threatening, controlled situations (BM). Highlights: A recent internet trend is watching 'pimple popping' (PP) videos. Investigation of personality traits that are associated with Pimple Popping Enjoyment (PPE). Benign masochism and morbid curiosity were predictors of PPE. PPE was associated with viewing behavior of PP videos. [ABSTRACT FROM AUTHOR]

Background: The carotid artery stenosis (CAS) is a notable risk element for ischemic stroke, accounting for 10 to 20% of such cases. There is a deficiency in research studies exploring the prognostic impact of CAS specifically in the anterior circulation acute ischemic stroke (AIS). Therefore, we conducted this study to evaluate the prognostic impact of CAS in individuals with anterior circulation AIS. Patients were categorized into two groups, patients with both anterior circulation AIS and CAS in comparison to patients with anterior circulation AIS without CAS (control group). We compared patient characteristics, neuroimaging, and outcome evaluations using a modified Rankin Scale (mRS) and the National Institute Health Stroke Scale (NIHSS) in both groups. P-value < 0.05 meaning statistical significance. Results: Fifty patients were involved in the current study; of them, 25 patients with both anterior circulation AIS and CAS and 25 patients with anterior circulation AIS without CAS. Both groups were comparable concerning age, gender, co-morbidities of diabetes, hypertension, smoking, and dyslipidemia with p-value > 0.05. The mean NIHSS was significantly elevated the CAS group compared to the control group (p = 0.037). Our results showed that patients with CAS ≥ 70% were associated with an mRS > 2 and a significantly higher NIHSS compared to control. The regression analysis showed that occlusion > 1/3, CAS ≥ 70%, and higher NIHSS score were considered independent predictors of mRS > 2. The mortality rate was significantly elevated in the CAS group versus the control group (p < 0.05). Both bilateral and unilateral CAS groups were comparable regarding NIHSS and mRS values. Conclusion: Patients with anterior circulation AIS who had CAS of 70% or more, whether unilateral or bilateral, showed a higher likelihood of increased mortality and more severe strokes, as evidenced by elevated NIHSS and mRS scores. [ABSTRACT FROM AUTHOR]

Background: Peripheral veno-arterial extracorporeal membrane oxygenation (pECMO) has become the first-line device in refractory cardiogenic shock (rCS). Some pECMO complications can preclude any bridging strategies and a peripheral-to-central ECMO (cECMO) switch can be considered as a bridge-to-decision. We conducted this study to appraise the in-hospital survival and the bridging strategies in patients undergoing peripheral-to-central ECMO switch. Methods: This retrospective monocenter study included patients admitted to a ECMO-dedicated intensive care unit from February 2006 to January 2023. Patients with rCS requiring pECMO switched to cECMO were included. Patients were not included when the cECMO was the first mechanical circulatory support. Results: Eighty patients, with a median [IQR25-75] age of 44 [29–53] years at admission and a female-to-male sex ratio of 0.6 were included in the study. Refractory pulmonary edema was the main switching reason. Thirty patients (38%) were successfully bridged to: heart transplantation (n = 16/80, 20%), recovery (n = 10/80, 12%) and ventricle assist device (VAD, n = 4/30, 5%) while the others died on cECMO (n = 50/80, 62%). The most frequent complications were the need for renal replacement therapy (76%), hemothorax or tamponade (48%), need for surgical revision (34%), mediastinitis (28%), and stroke (28%). The in-hospital and one-year survival rates were 31% and 27% respectively. Myocardial infarction as the cause of the rCS was the only variable independently associated with in-hospital mortality (HR 2.5 [1.3–4.9], p = 0.009). Conclusions: The switch from a failing pECMO support to a cECMO as a bridge-to-decision is a possible strategy for a very selected population of young patients with a realistic chance of heart function recovery or heart transplantation. In this setting, cECMO allows patients triage preventing from wasting expensive and limited resources. [ABSTRACT FROM AUTHOR]

Angiogenesis, metastasis, and resistance to therapy are all facilitated by cancer-associated fibroblasts (CAFs). A CAF-based risk signature can be used to predict patients' prognoses for Lung adenocarcinoma (LUAD) based on CAF characteristics. The Gene Expression Omnibus (GEO) database was used to gather signal-cell RNA sequencing (scRNA-seq) data for this investigation. The GEO and TCGA databases were used to gather bulk RNA-seq and microarray data for LUAD. The scRNA-seq data were analyzed using the Seurat R program based on the CAF markers. Our goal was to use differential expression analysis to discover differentially expressed genes (DEGs) across normal and tumor samples in the TCGA dataset. Pearson correlation analysis was utilized to discover prognostic genes related with CAF, followed by univariate Cox regression analysis. Using Lasso regression, a risk signature based on CAF-related prognostic genes was created. A nomogram model was created based on the clinical and pathological aspects. 5 CAF clusters were identified in LUAD, 4 of which were associated with prognosis. From 2811 DEGs, 1002 genes were found to be significantly correlated with CAF clusters, which led to the creation of a risk signature with 8 genes. These 8 genes were primarily connected with 41 pathways, such as antigen paocessing and presentation, apoptosis, and cell cycle. Meanwhile, the risk signature was significantly associated with stromal and immune scores, as well as some immune cells. Multivariate analysis revealed that risk signature was an independent prognostic factor for LUAD, and its value in predicting immunotherapeutic outcomes was confirmed. A novel nomogram integrating the stage and CAF-based risk signature was constructed, which exhibited favorable predictability and reliability in the prognosis prediction of LUAD. CAF-based risk signatures can be effective in predicting the prognosis of LUAD, and they may provide new strategies for cancer treatments by interpreting the response of LUAD to immunotherapy. [ABSTRACT FROM AUTHOR]

Mathematical performance, a competitive edge for children, has received ample attention from stakeholders, especially from parents. However, the association between parenting style and children's mathematics performance remains open to debate, and longitudinal studies are lacking. Therefore, this study used longitudinal data from four waves of surveys (2012, 2014, 2016, and 2018), with an initial sample of 1042 children (51.5% girls) aged 11, 13, and 15 years. Positive associations between supportive parenting style and higher mathematics scores were observed across all waves, both in unadjusted and adjusted generalized linear regression models, with all p < 0.05. Even after running five sets of sensitivity analyses (e.g., controlling counting skills in toddlerhood, imputing key covariates), the positive association remained robust. Ultimately, we found that supportive parenting style was positively associated with improved mathematical performance in adolescents measured up to six years later. This finding underscores the importance of supportive parenting in enhancing adolescents' mathematical performance and suggests that integrating supportive parenting strategies into family-based approaches may effectively improve children's mathematical achievements. [ABSTRACT FROM AUTHOR]

The gross calorific value (GCV) of coal is an important parameter for evaluating coal quality, and regression analysis methods can be used to predict GCV. In this study, we proposed a GCV prediction model based on cubist regression. To develop a good regression model, feature selection of input variables was performed using a correlation analysis and a recursive feature elimination algorithm. Thus, in this study, we determined three sets of variables as the optimal combination for regression models: proximate analysis variables (Set 1: moisture, standard ash, and volatile matter), element analysis variables (Set 2: carbon, sulfur, and oxygen), and comprehensive index variables (Set 3: carbon, volatile matter, standard ash, sulfur, moisture, and hydrogen). Results for comparison with multiple linear regression, random forest regression, and numerous previous prediction models, such as gradient boosting regression tree, support vector regression (SVR), backpropagation neural networks, and particle swarm optimization–artificial neural network (PSO-ANN), indicate that these seven regression models have the best fitting effect on the comprehensive index variables among the three sets of input variables. The cubist model showed higher prediction accuracy and lower error than most other models (R2, mean absolute error, root mean square error, and average absolute relative deviation percentage values are 0.990, 0.476, 0.668, and 0.086% for the proximate analysis variables; 0.992, 0.381, 0.596, and 0.140% for element analysis variables; and 0.999, 0.161, 0.219, and 0.087% for comprehensive index variables, respectively). The cubist model combines the advantages of decision tree and linear regression, which not only enables it to perform well in terms of accuracy but also makes the model highly interpretable because it is based on multiple sublinear equations. In addition, the cubist model shows obvious advantages in terms of running speed, especially compared with SVR and PSO-ANN, which require complex parameter optimization. In summary, the cubist model considers the prediction accuracy, model interpretability, and computational efficiency as well as provides a new and effective method for GCV prediction. [ABSTRACT FROM AUTHOR]

Xiong'an New Area was established as a state-level new area in 2017 and serves as a typical representative area for studying the ecological evolution of rural areas under rapid urbanization in China. Remote sensing-based ecological index (RSEI) is a regional eco-environmental quality (EEQ) assessment index. Many studies have employed RSEI to achieve rapid, objective, and effective quantitative assessment of the spatio-temporal changes of regional EEQ. However, research that combines RSEI with machine learning algorithms to conduct multi-scenario simulation of EEQ is still relatively scarce. Therefore, this study assessed and simulated EEQ changes in Xiong'an and revealed that: (1) The large-scale construction has led to an overall decline in EEQ, with the RSEI decreasing from 0.648 in 2014 to 0.599 in 2021. (2) Through the multi-scenario simulation, the non-unidirectional evolution of RSEI during the process of urban-rural construction has been revealed, specifically characterized by a significant decline followed by a slight recovery. (3) The marginal effects of urban-rural construction features for simulated RSEI demonstrate an inverted "U-shaped" curve in the relationship between urbanization and EEQ. This indicates that urbanization and EEQ may not be absolute zero-sum. These findings can provide scientific insights for maintaining and improving the regional EEQ in urban-rural construction. [ABSTRACT FROM AUTHOR]

In this study conducted along the coast of Odisha, India, reproductive trade-offs in isopods of the family Cymothoidae were investigated, focusing on the relationship between the number vs. volume of eggs and the percentage of brood to body volume. Ovigerous females from species with substantial sample sizes (n > 30) were analyzed to understand their survival strategies. The findings highlight distinct strategies among different parasite types within Cymothoidae. Buccal parasites such as Cymothoa frontalis and Cymothoa indica, along with branchial parasites like Joryma sawayah and Agarna malayi, generally produced a higher number of smaller eggs, except for A. malayi, which produced fewer but larger eggs. In contrast, the external body surface-attaching parasite, Nerocila orbignyi, was observed to produce fewer eggs of larger size. Across all parasite types (intraspecific), there was a statistically significant negative correlation between egg number and egg volume (p < 0.05). Buccal parasites were observed to have the highest percentage of marsupium volume relative to body volume, indicating a strategy to maximize egg storage. Conversely, external body surface-attaching parasites had the lowest percentage, possibly reflecting adaptation to a different reproductive environment. Additional observations revealed anatomical adaptations in all the studied isopod species which include the shift of the alimentary canal to the dorsal side to accommodate the development of the marsupial sac for egg incubation. In summary, these findings illustrate how parasitic isopods of the family Cymothoidae manage trade-offs between reproductive potential and success, crucial for their species’ continuity and survival strategies in coastal ecosystems. [ABSTRACT FROM AUTHOR]

Purpose: An official autism diagnosis is required to access timely intervention and is associated with better long-term wellbeing and mental health. Certain demographic characteristics, such as being female or a racially or ethnically minoritized youth, have been associated with significant diagnostic lag. However, it remains unclear how assigned sex, race, and ethnicity interact with each other in predicting the prevalence and age of autism diagnosis. Methods: To examine the interactions between assigned sex, race, and ethnicity, we used data from the National Survey of Children's Health (NSCH; 2016 > 2021). Results: One in 38 children had an autism diagnosis and 3.8 males were diagnosed per 1 female. Hierarchical linear regressions yielded diagnostic delays in some females, particularly those who were non-Hispanic white, Black, and Asian. Ethnic and racial minority children had significantly earlier diagnoses than white and non-Hispanic children when not accounting for sex. Conclusion: This study demonstrates slight increases in reported autism prevalence, a diagnostic lag in some autistic females that was strongly associated with ethnicity, and earlier diagnoses in racial and ethnic minority youth, a finding that may be explained by factors associated with phenotypic differences. This study has important implications for the diagnosis of minority autistic youth, particularly females and females who are non-Hispanic, who may experience a greater propensity for diagnostic delays. [ABSTRACT FROM AUTHOR]

Purpose: Although there is growing interest in telehealth to deliver parent-mediated intervention for autistic children, empirical evaluations are limited, and little is known regarding the relative benefits of self-directed and therapist-assisted telehealth interventions. This study examined the effect of self-directed and therapist-assisted ImPACT Online on parent learning and well-being, moderators of treatment, and predictors of program engagement. Method: Sixty-four young autistic children and their primary caregiver participated. Children were matched on age and developmental quotient and randomly assigned to a therapist-assisted, self-directed, or resource support control group. Participants were assessed at intake, after 6 months (post), and at a 3-month follow-up. Results: There was a significant treatment effect for parent learning for the therapist-assisted but not self-directed program; when analysis was limited to parents who completed the program, treatment effects were observed for both groups. There were no treatment effects for parent self-efficacy or parenting stress; however, there was an effect on parents' perception of their child's positive impact. Parenting stress did not moderate the effect of group on parent outcomes. Parent age, program satisfaction, and therapist assistance were all significant predictors of parent program engagement. Conclusion: This study supports the efficacy of therapist-assisted telehealth parent-mediated intervention for teaching parents intervention strategies to support their child's social communication and improving their perceptions of their child's positive impact, and suggests that self-directed programs may be beneficial for parents who fully engage with the program. [ABSTRACT FROM AUTHOR]

Background: A bridge to surgery (BTS) after self-expandable metallic stent (SEMS) placement is a widely recognized treatment strategy for obstructive colorectal cancer. However, there is still a lack of evidence for the efficacy and safety of laparoscopic surgery following SEMS placement. The aim of this systematic review and meta-analysis was to compare the short-term and long-term outcomes of laparoscopic surgery with those of open surgery following SEMS placement in patients with obstructive colorectal cancer. Methods: An electronic literature search through to December 2022 was performed to identify studies comparing short-term and long-term outcomes between laparoscopic and open surgery following SEMS placement for obstructive colorectal cancer. The main outcome measures were postoperative complication rates and mortality. Secondary outcome measures were the 3-year recurrence-free survival (RFS) and 3-year overall survival (OS) rates. The meta-analysis was performed using fixed-effect or random-effects methods to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs). Results: The meta-analysis included 15 studies and 883 patients, of whom 467 (52.9%) underwent laparoscopic surgery and 416 (47.1%) underwent open surgery following SEMS placement. The postoperative complication rate was significantly lower in the laparoscopic surgery group than in the open surgery group (OR 0.47, 95% CI 0.32–0.67, P < 0.001). There was no significant difference in the 3-year RFS rate or 3-year OS rate between the laparoscopic and open surgery groups (3-year RFS, OR 0.78, 95% CI 0.50–1.24, P = 0.30; 3-year OS, OR 0.68, 95% CI 0.41–1.12, P = 0.13). Conclusion: This meta-analysis found that the short-term outcome was better in patients who underwent laparoscopic surgery following SEMS placement than in those who underwent open surgery. Furthermore, there was no significant difference in long-term outcomes between the two groups. Laparoscopic surgery following SEMS placement may be a safe and effective treatment option for obstructive colorectal cancer. [ABSTRACT FROM AUTHOR]

Background: Surgical decision-making for preference-sensitive operations among older adults is understudied. Ventral hernia repair (VHR) is one operation where granular data are limited to guide preoperative decision-making. We aimed to determine risk for VHR in older adults given clinically nuanced data including surgical and hernia characteristics. Methods: We performed a retrospective analysis of the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry from January 2020 to March 2023. The primary outcome was postoperative complication across age groups: 18–64, 65–74, and ≥ 75 years, with secondary outcome of surgical approach. Mixed-effects logistic regression evaluated association between minimally invasive surgery (MIS) and 30-day complications, controlling for patient and hernia characteristics. Results: Among 8,659 patients, only 7% were 75 or older. MIS rates varied across hospitals [Median = 31.4%, IQR: (14.8–51.6%)]. The overall complication rate was 2.2%. Complication risk for undergoing open versus MIS approach did not vary between age groups; however, patients over age 75 undergoing laparoscopic repair had increased risk (aOR = 4.58, 95% CI 1.13–18.67). Other factors associated with risk included female sex (aOR = 2.10, 95% CI 1.51–2.93), higher BMI (aOR = 1.18, 95% CI 1.03–1.34), hernia width ≥ 6 cm (aOR = 3.15, 95% CI 1.96–5.04), previous repair (aOR = 1.44, 95% CI 1.02–2.05), and component separation (aOR = 1.98, 95% CI 1.28–3.05). Patients most likely to undergo MIS were female (aOR = 1.21, 95% CI 1.09–1.34), black (aOR = 1.30, 95% CI 1.12–1.52), with larger hernias: 2–5.9 cm (aOR = 1.76, 95% CI 1.57–1.97), or intraoperative mesh placement (aOR = 14.4, 95% CI 11.68–17.79). There was no difference in likelihood to receive MIS across ages when accounting for hospital (SD of baseline likelihood = 1.53, 95% CI 1.14–2.05) and surgeon (SD of baseline likelihood = 2.77, 95% CI 2.46–3.11) variation. Conclusions: Our findings demonstrate that hernia, intraoperative, and patient characteristics other than age increase probability for complication following VHR. These findings can empower surgeons and older patients considering preoperative risk for VHR. [ABSTRACT FROM AUTHOR]

Background: The association between surgical performance ratings and clinical outcomes in robotic surgery is poorly understood. Additionally, no studies have reported on the relationship between the surgeon's initial case-skill evaluation and the learning curve in robot-assisted surgery. We evaluated whether an objective surgical technique evaluation score for initial robot-assisted radical prostatectomy (RARP) was associated with clinical outcomes and surgeons' learning curves. Methods: Six surgeons who were trained in and started to perform RARP at our institution were included. Anonymized, unedited videos of each surgeon's 10th RARP case were evaluated by three reviewers, using modified Objective Structured Assessment of Technical Skill (OSATS) scores. We then divided the surgeons into two groups on the basis of these OSATS scores. We retrospectively compared the clinical outcomes and learning curves of the console time of the two groups for consecutive RARPs, performed from March 2018 to July 2023. Results: We analyzed 258 RARPs (43 cases/surgeon), including 129 cases performed by high-OSATS score surgeons (18.2–19.3 points) and 129 cases performed by low-OSATS score surgeons (11.9–16.0 points). Overall, the high-OSATS score group had significantly shorter operation and console times than the low-OSATS score group did (both P < 0.01) and their patients' rate of continence recovery by 3 months post-RARP was significantly higher (P = 0.03). However, complications, blood loss, and positive margins did not differ between the groups (P = 0.08, P = 0.51, and P = 0.90, respectively). The high-OSATS score group had a significantly shorter console time than the low-OSATS score group did after the 11–20 cases. Conclusions: The OSATS score in early RARP cases can predict subsequent surgical outcomes and surgeons' learning curves. [ABSTRACT FROM AUTHOR]

Objective: Textbook outcome (TO) is widely recognized as a comprehensive prognostic indication for patients with gastric cancer (GC). This study aims to develop a modified TO (mTO) for elderly patients with GC. Methods: Data from the elderly patients (aged ≥ 65 years) in two Chinese tertiary referral hospitals were analyzed. 1389 patients from Fujian Medical University Union Hospital were assigned as the training cohort and 185 patients from Affiliated Hospital of Putian University as the validation cohort. Nomogram was developed by the independent prognostic factors of Overall Survival (OS) based on Cox regression. Results: In the training cohort, laparoscopic surgery was significantly correlated with higher TO rate (P < 0.05). Cox regression analysis revealed that surgical approach was also an independent factor of OS (P < 0.001), distinct from the traditional TO. In light of these findings, TO parameters were enhanced by the inclusion of surgical approach, rendering a modified TO (mTO). Further analysis showed that mTO, tumor size, pTNM staging, and adjuvant chemotherapy were independent prognostic factors associated with OS (all P < 0.05). Additionally, the nomogram incorporating these four indicators accurately predicted 1-, 3-, and 5-year OS in the training cohort, with AUC values of 0.793, 0.814, and 0.807, respectively, and exhibited outstanding predictive performance within the validation cohort. Conclusion: mTO holds a robust association with the prognosis of elderly patients with GC, meriting intensified attention in efforts aimed at enhancing surgical quality. Furthermore, the predictive model incorporating mTO demonstrates excellent predictive performance for elderly patients with GC. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is the 5th most common malignancy worldwide. Surgical treatment for the disease can often be highly morbid, especially in elderly patients. The modified 5-item frailty index (mFI-5), a recently developed tool for assessing patient frailty, has been shown to be an effective predictor of post-operative outcomes in various surgical fields. This study aims to assess the utility of the mFI-5 in predicting adverse postoperative outcomes following gastrectomy for gastric cancer. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent partial or total gastrectomy for gastric cancer between 2011 and 2021. The mFI-5 score was calculated based on the presence of hypertension, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, and partially or fully dependent functional status. Patients were stratified into 3 groups according to mFI-5 score (mFI-5 = 0, mFI-5 = 1, mFI-5 ≥ 2). Univariate analysis and multivariate logistic regression were used to evaluate the association between mFI-5 score and post-operative outcomes. Results: 7438 patients were identified (mFI-5 = 0: 3032, mFI-5 = 1: 2805, mFI-5 ≥ 2: 1601). mFI-5 ≥ 2 was an independent predictor of overall complications (OR 1.43, p < 0.001), serious complications (OR 1.42, p < 0.001), pneumonia (OR 1.43, p = 0.010), MI (OR 2.91, p = 0.005), and readmission within 30 days (OR 1.33, p = 0.008). Patients with higher frailty were more likely to experience unplanned intubation (OR 2.06, p < 0.001; OR 2.47, p < 0.001), failure to wean from the ventilator (OR 1.68, p = 0.003; OR 2.00, p < 0.001), acute renal failure (OR 3.25, p = 0.003; OR 3.27, p = 0.005), 30-day mortality (OR 1.73, p = 0.009; OR 1.94, p = 0.004), and non-home discharge (OR 1.34, p = 0.001; OR 1.74, p < 0.001) relative to non-frail patients. Conclusion: Higher frailty, as indicated by an increased mFI-5 score, raises the risk of serious post-operative complications in patients with gastric cancer undergoing gastrectomy. The mFI-5 has the potential to help identify high-risk patients and enhance pre-operative discussions and optimization. [ABSTRACT FROM AUTHOR]

Background: Although several studies have suggested a potential positive association between serum vitamin D levels and muscle strength in older adults, it remains unclear whether this relationship is sex-dependent. Aim: To evaluate the association between serum 25 hydroxyvitamin D [25(OH)D] levels and muscle strength in older adults and to assess whether this association is dependent on sex. Methods: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2002. A total of 1173 individuals aged 50–85 years (630 men and 543 women) were included in the analysis. The peak isokinetic force of the knee extensor was assessed using a kinetic communicator isokinetic dynamometer. Serum 25(OH)D levels were measured using the standardized liquid chromatography-tandem mass spectrometry method. Linear regression analyses were conducted to estimate coefficients and 95% confidence intervals for muscle strength across tertiles of serum vitamin D levels, adjusting for potential confounders. Results: Tertiles of serum vitamin D were positively associated with muscle strength in older men (p-trend = 0.007), whereas no association was observed in older women (p-trend = 0.140) or in the total sample (men and women together; p-trend = 0.139). Conclusion: Serum vitamin D levels were positively associated with muscle strength specifically in older men, whereas no association was observed in older women. These results suggest that the relationship between vitamin D and strength may be sex-dependent. [ABSTRACT FROM AUTHOR]

Background: Patients with migraine are vulnerable to insufficient sleep, but the impact of sleep restriction is largely unknown. In addition, the importance of sleep may be different in patients with migraine who mostly have attack onsets during sleep, so called sleep-related migraine, compared to patients with non-sleep-related migraine. In this study we investigate the effect of sleep restriction on endogenous pain modulation in patients with migraine and healthy controls. We also compared the effect of sleep restriction in sleep-related and in non-sleep-related migraine. Methods: Measurements were conducted in 39 patients with migraine between attacks and 31 controls, once after habitual sleep and once after two consecutive nights of partial sleep restriction. There were 29 and 10 patients with non-sleep-related and sleep-related migraine respectively. Test stimulus was 2-min tonic noxious heat to the left volar forearm. Temporal summation was calculated as the regression coefficient for rated pain in the late part of this 2-min stimulation. Conditioning stimulus was right hand-immersion in 7 °C water. Conditioned pain modulation was defined as the difference in rated pain with and without the conditioning stimulus and was calculated for temporal summation and mean rated pain for the test stimulus. The effect of sleep restriction on temporal summation and conditioned pain modulation was compared in migraine subjects and controls using two-level models with recordings nested in subjects. Results: Conditioned pain modulation for temporal summation of heat pain tended to be reduced after sleep restriction in patients with migraine compared to controls (p = 0.060) and, in an exploratory analysis, was reduced more after sleep restriction in sleep-related than in non-sleep-related migraine (p = 0.017). No other differences between groups after sleep restriction were found for temporal summation or conditioned pain modulation. Conclusion: Patients with migraine may have a subtly altered endogenous pain modulation system. Sleep restriction may have an increased pronociceptive effect on this system, suggesting a mechanism for vulnerability to insufficient sleep in migraine. This effect seems to be larger in sleep-related migraine than in non-sleep-related migraine. [ABSTRACT FROM AUTHOR]

Background: Family functioning is associated with adolescent drug use, alcohol use, cigarette use, and sexual risk behaviors. Assessing adolescents for family functioning, commonly associated with multiple risk behaviors, may help identify adolescents at risk for adverse health outcomes. This study examined whether a latent family functioning construct, encompassing multiple dimensions of family functioning, was associated with adolescents' substance use and sexual risk behaviors. Method: This study used data harmonization with three intervention trials, including data from 1451 adolescents (M = 13.6, SD = 1.0), to perform a full-information item bifactor analysis on 46 family functioning items from five pre-existing family functioning measures. Regression analysis was used to examine the association between the identified subset of items and the following outcomes: cigarette use, alcohol use, drug use, and condom use. Results: Bifactor analysis identified a 26-item latent family functioning construct. Regression analysis indicated that a 26-item latent family functioning construct was associated negatively with lifetime and past 90-day cigarette use, alcohol use, and drug use. Conclusion: In sum, the multi-dimensional latent family functioning construct may target specific barriers to risk screening in adolescent populations, including time constraint, hesitancy in discussing sensitive health topics, and use culturally appropriate and age-appropriate assessments. [ABSTRACT FROM AUTHOR]

Previous research has reported high occult nodal metastases rates for T3/T4 mucoepidermoid carcinoma (MEC) of the oropharynx (OP) and oral cavity (OC). Our study evaluates if there is a benefit of neck dissection (ND) in these patients. The 2004–2016 National Cancer Database was queried for cases of adult MEC of the OC and OP. Patients with clinical T3/T4 disease were included while those with metastatic disease were excluded. Patients were divided into two cohorts: those treated with and without ND. Univariate chi-square, Kaplan-Meier, and multivariable Cox regression analyses were implemented. A total of 243 patients met inclusion criteria, of which 79 (32.5%) underwent ND. The majority of patients were less than 60 years old (60.1%), White (76.2%), and male (53.5%). 92 (37.9%) patients had clinically node-positive (cN+) disease. ND patients had higher rates of cN + disease (53.2% vs. 30.5%, p = 0.002). Of patients undergoing ND, 35 (44.3%) had cN0 disease while 42 (53.2%) had cN + disease. ND patients more commonly had grade III/IV tumors (45.1% vs. 23.4%, p = 0.002). Upon examination of dissected nodes, 20.3% of cN0 patients undergoing ND were found to have occult nodal metastases. There was no significant difference in 5-year overall survival between patients with and without ND (61.8% vs. 53.6%, p = 0.610), even on multivariable Cox analysis (hazard ratio: 1.52, 95% confidence interval: 0.73–3.18, p = 0.269). Our study found patients with cN0 MEC of the OC and OP have a high rate (20.3%) of occult nodal metastasis. In this cohort, patients with ND were not found to have improved survival, possibly due to statistical underpowering. Further research is needed to evaluate the indications and benefit of ND for this rare tumor presentation. Keypoints: Previous research has reported high occult nodal metastases rates for T3/T4 mucoepidermoid carcinoma (MEC) of the oropharynx (OP) and oral cavity (OC). Neck dissection patients had higher rates of cN + disease and more commonly had grade III/IV tumors. Patients with MEC of the OP and OC have a high rate of occult nodal metastasis, suggesting neck dissection should be given strong consideration for these patients. There was no significant difference in 5-year overall survival between patients treated with and without neck dissection. [ABSTRACT FROM AUTHOR]

In this research paper, we explored the predictive capabilities of three different models of Polynomial Regression (PR), Extreme Gradient Boosting (XGB), and LASSO to estimate the density of supercritical carbon dioxide (SC-CO2) and the solubility of niflumic acid as functions of the input variables of temperature and pressure. The optimization of hyperparameters for these models is achieved using the innovative Barnacles Mating Optimizer (BMO) algorithm. For SC-CO2 density estimation, PR exhibits remarkable accuracy, showing an R-squared value of 0.99207 for data fitting. XGB performs admirably with an R2 of 0.92673, while LASSO model demonstrates good predictive ability, showing an R2 of 0.81917. Furthermore, we assess the models' performance in predicting the solubility of niflumic acid. PR exhibits excellent predictive capabilities with an R2 of 0.96949. XGB also delivers strong performance, yielding an R-squared score of 0.92961. LASSO performs well, achieving an R-squared score of 0.82094. The results indicated promising performance of machine learning models and optimizer in estimating drug solubility in supercritical CO2 as the solvent applicable for pharmaceutical industry. [ABSTRACT FROM AUTHOR]

Background: Self-perceived quality of life (QoL) is important in amyotrophic lateral sclerosis (ALS). Although caregiver burden and strain have been related to cognitive and behavioural impairment, there has been no comprehensive research looking at these impairments and how they may influence self-perceived QoL subdomains. Aims: To explore how cognitive and behavioural impairment are related to different areas of self-perceived QoL using disease-specific measures. Methods: This was a quantitative, cross-sectional, observational cohort study, utilising existing specialist ALS clinic data. Clinical and demographic variables were available as well as multidimensional measures, ALS-specific QoL Short Form (ALSsQoL-SF) results and the data from the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Group comparison and regression analyses were performed. Results: Data from 121 participants with ALS were analysed. 61.2% (N = 74) had either cognitive and/or behavioural impairment, with 28.9% (N = 35) with cognitive impairment (ALSci), 14.1% (N = 17) with behavioural impairment (ALSbi) and 18.2% (N = 22) with both (ALScbi). 38.8% (N = 47) were classified as having no impairments (ALSni). Those with ALSbi had significantly lower QoL in the domains of negative emotions and the interaction with people and the environment compared to those with ALSci and ALSni (ps < 0.05). Further, those with ALScbi had significantly lower QoL in the intimacy domains than those with ALSci and ALSni (ps < 0.05). Regression analysis showed specific cognitive and behavioural (inclusive of psychosis) predictors associated with specific QoL subdomains. Conclusions: Behavioural impairments effect QoL in specific subdomains, namely relating to internalising (negative emotions) and externalising (interaction with people and the environment subdomains, intimacy). [ABSTRACT FROM AUTHOR]

Rock abrasivity plays an important role in the machine design, construction scheduling, and budgeting of TBM projects. Establishing several faster and simpler estimation equations for the Cerchar Abrasivity Index (CAI) of rocks is, therefore, very important. This study investigated the correlation between the CAI and mechanical properties of rock, rock mass classification parameters, and machine performance. A TBM construction database including 159 tunnel sections is established. Several acceptable and practical estimation equations of CAI are developed using simple and multiple regression analysis (0.66 < R2 < 0.76). In this process, a normalized specific energy is proposed to evaluate the machine performance. The results show that the rock compressive strength and brittleness index are the most dependent parameters to explain CAI, and the estimated rock mass strength also indicates a close correlation. In addition, the contribution of a rock mass classification system and machine performance index for estimating CAI cannot be ignored. Finally, the estimation performance of the developed equations is compared and evaluated, and a new method for selecting an optimal model based on ranking is proposed. Since the input parameters of the proposed equations can be readily available at the project planning stage, they are very practical for TBM designers, tunnel designers, and contractors. Highlights: The correlations between the CAI and rock mechanical properties, rock mass classification parameters, and machine performance are investigated. A normalized specific energy index is proposed for assessing the performance of rocks excavation by TBMs. Several acceptable and practical estimation equations of CAI are developed using simple and multiple regression analysis. A new method for selecting optimal estimation model based on ranking is presented. [ABSTRACT FROM AUTHOR]

Background: To investigate the potential utility of quantitative parameters obtained by 18F-fibroblast activation protein inhibitor positron emission tomography/computed tomography ([18F]AlF-NOTA-FAPI-04 PET/CT) in the assessment of organ involvement and disease activity in IgG4-related disease (IgG4-RD). Methods: This study enrolled patients who underwent [18F]AlF-NOTA-FAPI-04 PET/CT scans at the Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine from August 2021 to August 2022. The PET/CT images of the included patients were re-evaluated by PET center technicians, and the maximal standardized uptake value (SUVmax), metabolic lesion volume (MLV), and total lesion FAPI (TL-FAPI) were used to evaluate the involved organs and tissues that abnormally accumulated [18F]AlF-NOTA-FAPI-04. The clinical and laboratory data of patients are also systematically collected and analyzed. Results: Among the patients included in this study, 12 patients met the IgG4-RD classification criteria established by the American College of Rheumatology in 2019. Among them, 8 were males and 4 were females, with an average age of 59.3 ± 11.5 years. 50% of IgG4-RD patients were found with more organ involvement on PET/CT than physical examination, ultrasonography, and computed tomography. IgG4 levels (Rho = 0.594, p = 0.042) and IgG4-RI (Rho = 0.647, p = 0.023) were significantly positively correlated with TL-FAPI. After linear regression analysis, only TL-FAPI showed a predictive value of RI (R2 = 0.356, B = 0.008, p = 0.041). Conclusions: [18F]AlF-NOTA-FAPI-04 PET/CT is a useful tool for identifying asymptomatic organ involvement and assessing disease activity. The TL-FAPI as an indicator was positively correlated with IgG4-RD disease activity. [ABSTRACT FROM AUTHOR]

Summary: Our study examined associations of the CXC motif chemokine ligand 9 (CXCL9), a pro-inflammatory protein implicated in age-related inflammation, with musculoskeletal function in elderly men. We found in certain outcomes both cross-sectional and longitudinal significant associations of CXCL9 with poorer musculoskeletal function and increased mortality in older men. This requires further investigation. Purpose: We aim to determine the relationship of (CXCL9), a pro-inflammatory protein implicated in age-related inflammation, with both cross-sectional and longitudinal musculoskeletal outcomes and mortality in older men. Methods: A random sample from the Osteoporotic Fractures in Men (MrOS) Study cohort (N = 300) was chosen for study subjects that had attended the third and fourth clinic visits, and data was available for major musculoskeletal outcomes (6 m walking speed, chair stands), hip bone mineral density (BMD), major osteoporotic fracture, mortality, and serum inflammatory markers. Serum levels of CXCL9 were measured by ELISA, and the associations with musculoskeletal outcomes were assessed by linear regression and fractures and mortality with Cox proportional hazards models. Results: The mean CXCL9 level of study participants (79.1 ± 5.3 years) was 196.9 ± 135.2 pg/ml. There were significant differences for 6 m walking speed, chair stands, physical activity scores, and history of falls in the past year across the quartiles of CXCL9. However, higher CXCL9 was only significantly associated with changes in chair stands (β = − 1.098, p < 0.001) even after adjustment for multiple covariates. No significant associations were observed between CXCL9 and major osteoporotic fracture or hip BMD changes. The risk of mortality increased with increasing CXCL9 (hazard ratio quartile (Q)4 vs Q1 1.98, 95% confidence interval 1.25–3.14; p for trend < 0.001). Conclusions: Greater serum levels of CXCL9 were significantly associated with a decline in chair stands and increased mortality. Additional studies with a larger sample size are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

The toll-like receptor (TLR) family is an important class of proteins involved in the immune response. However, little is known about the association between TLRs and Esophageal squamous cell cancer (ESCC). We explored differentially expressed genes (DEGs) between ESCC and esophagus tissues in TCGA and GTEx database. By taking the intersection with TLR gene set and using univariate Cox analysis and multivariate Cox regression analysis to discriminate the hub genes, we created a TLR-prognostic model. Our model separated patients with ESCC into high- and low-risk score (RS) groups. Prognostic analysis was performed with Kaplan–Meier curves. The two groups were also compared regarding tumor immune microenvironment and drug sensitivity. Six hub genes (including CD36, LGR4, MAP2K3, NINJ1, PIK3R1, and TRAF3) were screened to construct a TLR-prognostic model. High-RS group had a worse survival (p < 0.01), lower immune checkpoint expression (p < 0.05), immune cell abundance (p < 0.05) and decreased sensitivity to Epirubicin (p < 0.001), 5-fluorouracil (p < 0.0001), Sorafenib (p < 0.01) and Oxaliplatin (p < 0.05). We constructed a TLR-based model, which could be used to assess the prognosis of patients with ESCC, provide new insights into drug treatment for ESCC patients and investigate the TME and drug response. [ABSTRACT FROM AUTHOR]

Purpose: Necrotizing fasciitis (NF) is a rare, but rapidly progressing bacterial infection of the subcutaneous tissues and muscular fascia with high rates of morbidity and mortality. Our study aims to determine if socioeconomic status (SES) is a predictor of outcomes in NF. Methods: A retrospective review was conducted of patients diagnosed with NF at our institution. Demographic information, insurance status, medical and surgical history, vitals, ASA score, blood laboratory values, surgical procedure information, and outcomes prior to patient discharge were collected. Patient zip codes were utilized to obtain median household incomes at the time of the patient's surgical procedure to determine SES. Patients without complete data in their medical record were excluded. Initial descriptive statistics and logistic regression models were performed. Results: We identified 196 patients (mean age 50.13 ± 13.03 years, 31.6% female) for inclusion. Mortality rate was 15.3% (n = 30) and 33.7% (n = 66) underwent amputation. Mortality rate was not significantly different across income brackets. Lower income brackets had higher rates of amputation than higher income brackets (p < 0.05). A logistic regression models showed the rate of amputation decreases by 29% for every $10,000 increment in median household income and ASA score decreased by 0.15 units for every $10,000 increase in median household income. Conclusions: Amputation rates in cases of NF are significantly higher in lower SES groups than higher SES groups. Patients with perivascular disease in lower SES groups were more likely to experience serious complications of NF than their counterparts in higher SES groups. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to establish the correlation of clinically measured carrying angle with four radiological angles, i.e., Humerus–Elbow–Wrist angle (HEWA), Humero-ulnar angle, Metaphyseal–Diaphyseal angle, and Baumann's angle, and to find out which of the above-mentioned angles co-relates best with the clinically measured carrying angle. Methods: We studied 100 patients in the age group of 2–12 years after Ethics committee approval and informed consent from parents. Clinical angle was measured using goniometer and radiological angles marked on antero-posterior elbow X-ray using a standard method. Collected data were studied using statistical tests to find out correlation. Results: Pearson correlation coefficient for humerus–elbow–wrist angle found to be 0.674 followed by Humero-Ulnar angle (r = 0.417). Regression coefficient for humerus–elbow–wrist angle is 0.635 (p value < 0.001). Conclusion: Humerus–Elbow–Wrist angle correlates better compared to other radiological angles in assessment of varus–valgus angulations of elbow & will not only play a vital role in pre- operative planning of deformity corrections but also in the evaluation & comparison of the post-operative functional outcomes. [ABSTRACT FROM AUTHOR]

Background: The neutrophil–lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) are emerging inflammatory markers related to cardiovascular outcomes. This study investigated their relationships with cardiovascular disease (CVD) and mortality among individuals with prediabetes or diabetes and assessed their predictive roles. Methods: A cohort of 6871 individuals with diabetes or prediabetes from the NHANES (2001–2018) was included. Weighted multivariate logistic regression models assessed NLR and SII associations with CVD risk, while survey-weighted Cox proportional hazards models evaluated their links to mortality. The predictive accuracy of the biomarkers for mortality was quantified by receiver-operating characteristic (ROC) curve analysis. Results: Individuals in the higher NLR and SII groups exhibited a high incidence of CVD. A total of 1146 deaths occurred throughout an average follow-up duration of 191 months, of which 382 were caused by CVD. Participants with higher NLR markedly increased the risk of all-cause (HR = 1.82) and cardiovascular mortality (HR = 2.07). A similar result was observed in the higher SII group. RCS analysis identified a linear correlation between NLR and CVD risk and mortality (p > 0.05), while SII showed a nonlinear correlation (p < 0.05). ROC results demonstrated that NLR exhibited a higher predictive ability in mortality than SII. Conclusions: Elevated levels of NLR and SII correlated with an increased risk of CVD and both all-cause and cardiovascular mortality in individuals with diabetes or prediabetes. The NLR appears to be particularly valuable for assessing risk and predicting outcomes in these patients. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease. We aimed to investigate the potential similarities and differences regarding the disease among Arabs and Jews. Retrospective study included all patients older than 18 years with NAFLD diagnosis according to ICD-10 codes. Data regarding demographics, comorbidities, and outcomes were retrieved using the MdClone platform from "Clalit" in Israel. Data concerning 34,090 Arab patients and 173,500 Jewish patients with NAFLD were included. Arab patients were significantly younger at diagnosis (35.0 ± 13 years vs. 43.6 ± 15 years, p < 0.001) and had higher rates of obesity and diabetes mellitus (69.5% vs. 56.5% and 27.0% vs. 22.7%, p < 0.001, respectively). Arab patients had higher rates of cirrhosis and portal hypertension-related complications (2.5% vs. 2.0%, p < 0.001), esophageal varices (0.9% vs. 0.5%, p < 0.001), spontaneous bacterial peritonitis (0.3% vs. 0.1%, p < 0.001), and hepatorenal syndrome (0.3% vs. 0.1%, p < 0.001). There was no significant difference in the prevalence of hepatocellular carcinoma between study groups (0.4% vs. 0.5%, p = 0.156). Liver transplantation was performed in 0.2% of Arab NAFLD patients compared to 0.07% of Jewish NAFLD patients (p < 0.001). Lower rates of all-cause mortality were found among the Arab NAFLD patients versus Jewish NAFLD patients (7.7% versus 11.5%, p < 0.001). According to the Cox regression model, Arab ethnicity is a risk factor for death with OR of 1.36. Significant differences regarding comorbidities, complications, liver transplantations rates, and all-cause mortality were found among NAFLD patients of different ethnicities, hence specific population need specific consideration in prevention, early diagnosis and follow up. [ABSTRACT FROM AUTHOR]

Many individuals with serious mental illness are at high risk for hospitalization or death due to inadequate treatment of medical conditions or unhealthy behaviors. The authors describe demographic and clinical characteristics associated with increased risk in this population. Electronic data were obtained for individuals in treatment at a large Veterans' healthcare system who were at high risk according to a validated model. A random sample of these individuals was assessed in person. Multivariable regressions estimated the effect of numerous demographic, health, and clinical characteristics on risk. Emergency visits and hospitalizations were common. Greater risk was associated with being male, not married, and having more diagnoses. While risk varied by race, this effect was no longer significant after controlling for other factors. Health-related quality of life worsened with increasing risk. Routine data identify a large population of high-risk individuals who may benefit from outreach to provide healthcare services. [ABSTRACT FROM AUTHOR]

Sleep is integral to cognitive functioning, and disturbances in sleep patterns can impair cognition. This study investigated the relationships between executive functions, sleep problems, and negative pre-sleep cognitions, proposing a model for their interaction. We assessed 107 adults using the Bedtime Counterfactual Processing Questionnaire and the Glasgow Content of Thoughts Inventory for negative pre-sleep cognitions, the Insomnia Severity Index and the Pittsburgh Sleep Quality Index for sleep problems, and the Free Research Executive Evaluation test battery for executive functions. Regression and mediation analyses were conducted to examine both direct and indirect relationships between these variables. Higher executive functions were associated with fewer negative pre-sleep cognitions, which in turn predicted fewer sleep problems. However, the anticipated direct effect of sleep problems on executive functioning was not supported, indicating a more complex interplay. Notably, pre-sleep cognition mediated the relationship between executive functions and sleep problems, indirectly affecting sleep problems through its connection with executive functions. While the findings support the mediation model of executive functions, negative pre-sleep cognitions, and sleep problems, the proposed cyclical model was not fully substantiated. This suggests that additional factors may influence the dynamics of this relationship, offering potential avenues for future research and interventions targeting sleep disorders and cognitive well-being enhancement. [ABSTRACT FROM AUTHOR]

Minimal data exist on whether the acid–base balance of the diet is linked to muscle strength. The aim of this study was to determine if dietary acid load is associated with grip strength in a nationally representative sample of middle- to older-age adults. We examined the cross-sectional association of grip strength with dietary acid load quantified through potential renal acid load (PRAL) and net endogenous acid production (NEAP) in 4,059 adults aged 50 years and older in the 2011–2014 NHANES survey cycles. PRAL and NEAP were estimated from two 24-h recalls and categorized into sex-specific quartiles. Grip strength was measured on a dynamometer. Multiple linear regression models were used to determine the associations of PRAL and NEAP (as quartiles) with grip strength for men and women separately, adjusting for total energy, age, race/ethnicity, weight, physical activity, smoking, serum 25-hydroxyvitamin D, and estimated glomerular filtration rate. Mean grip strength was 26.8 ± 0.2 kg in women and 43.0 ± 0.4 kg in men. Adjusted grip strength was inversely associated with quartiles of PRAL (ptrend = 0.049) and NEAP (ptrend = 0.034) in women with quartile 4 vs 1 differences of − 1.21 and − 1.08 kg (both p < 0.05), respectively. Adjusted grip strength was not associated with PRAL or NEAP in men. Overall, we found inverse associations between dietary acid load and grip strength in middle- and older-age women, suggesting that an alkaline diet may be important in maintaining muscle strength in this population. There was no association between dietary acid load and grip strength in men. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic negatively affected physical and psychological health worldwide. Pregnant women were likely more vulnerable to mental health difficulties due to the significant social, psychological, and hormonal changes they experience. During the pandemic, higher rates of antenatal depression and anxiety were observed compared to pre-pandemic rates. Increased mental health symptoms in pregnancy have been associated with adverse outcomes for child development. Understanding pandemic-specific preventive behaviours (i.e., mask use, physical distancing) and concerns may also be linked to maternal psychological well-being. Purpose: To compare matched pregnant and non-pregnant women (N = 474) to assess COVID-19 psychosocial impacts, preventive behaviours, and concerns. Methods: This study used a matched analysis of data collected by the International COVID-19 Awareness and Responses Evaluation (iCARE) Study. Participants were matched on several demographic factors and analyses were adjusted for chronic illness and psychiatric disorder. Results: Linear regression analyses indicated that pregnant women did not significantly differ from matched non-pregnant women for psychosocial impacts (B = 0.11, SE = 0.08, p = 0.178). Those who reported a chronic illness (B=-0.19, SE = 0.09, p = 0.036) or a psychiatric disorder (B=-0.28, SE = 0.09, p = 0.003) were more likely to report more significant psychosocial impacts. Logistic regression analyses indicated that pregnant women were more likely to report staying at home rather than going to work (OR = 2.01, 95% CI 1.31–3.08, p = 0.002) and being concerned about being infected (OR = 1.61, 95% CI 1.05–2.46, p = 0.028). Conclusions: Our findings in the context of the COVID-19 pandemic highlight the need to consider interventions targeting women, with chronic illnesses or psychiatric disorders, as they are often the most vulnerable. [ABSTRACT FROM AUTHOR]

Purpose: Attention-deficit hyperactivity disorder (ADHD) is becoming more commonly diagnosed in women, consequently, more women of reproductive age are taking ADHD medication, such as dexamphetamine. However, the safety associated with continuing or ceasing dexamphetamine during pregnancy is unclear. This study investigates outcomes associated with the continuation of dexamphetamine during pregnancy compared to those who ceased or were unexposed. Methods: A population-based retrospective cohort of women from Western Australia who had been dispensed dexamphetamine during pregnancy and gave birth between 2003 and 2018. Women had either continued to take dexamphetamine throughout pregnancy (continuers, n = 547) or ceased dexamphetamine before the end of the second trimester (ceasers, n = 297). Additionally, a matched (1:1) comparison group of women who were dispensed an ADHD medication prior to pregnancy but not during pregnancy (unexposed) was included in the study (n = 844). Multivariable generalised linear models were used to compare maternal and neonatal health outcomes. Results: Compared to continuers, ceasers had greater odds of threatened abortion (OR: 2.28; 95%CI: 1.00, 5.15; p = 0.049). The unexposed had some benefits compared to the continuers, which included lower risk of preeclampsia (OR: 0.58; 95%CI: 0.35, 0.97; p = 0.037), hypertension (OR: 0.32; 95%CI: 0.11, 0.93; p = 0.036), postpartum haemorrhage (OR: 0.57; 95%CI: 0.41, 0.80; p = 0.001), neonatal special care unit admittance (OR: 0.16; 95%CI: 0.12, 0.20; p < 0.001) and fetal distress (OR: 0.73; 95%CI: 0.54, 0.99; p = 0.042). Conclusion: Continuing dexamphetamine throughout pregnancy was not associated with an increase in adverse neonatal and maternal health outcomes compared to ceasing. Ceasing dexamphetamine during pregnancy was associated with increased odds of threatened abortion compared with continuing dexamphetamine. However, this is something that requires further investigation due to the small sample size, difficulties examining timing, and the inability to examine spontaneous abortions. The unexposed showed some benefits compared to the continuers, suggesting that where possible the cessation of dexamphetamine prior to pregnancy may be advisable. [ABSTRACT FROM AUTHOR]

Purpose: To compare social, clinical, and migration-related factors between male and female immigrants with psychotic disorders and to determine the association between these variables and stress in the last year. Methods: We administered the Holmes and Rahe Social Readjustment Scale to evaluate psychological stress in 99 non-refugee immigrants (26 women, 73 men) who presented ≥ one psychotic episode (ICD-10 criteria). We compared the two groups in terms of sociodemographic, clinical, cultural, and migration-related variables. A multivariable analysis using a linear regression model (stepwise method) was performed to evaluate potential associations between these variables and stress. Results: Women were more likely to be married and divorced, had less access to welfare payments, and lower unemployment and homeless rates than men. The most common psychiatric diagnosis was psychosis not otherwise specified with more women being affected (61.5% in women vs. 45.2% in men), but the diagnosis of schizophrenia was more common in men (38.4% vs 15.4%). Both groups exhibited very high levels of stress in the past year (mean total distress score > 300). In women, stress was significantly associated with age at first migration and be a racialized person. By contrast, among men stress was significantly associated with language barrier and comorbidity with a physical disorder. Conclusions: The results of this study reveal important differences between men and women immigrants. These findings underscore the importance of understanding how gender-specific roles and social expectations intersect with the timing and nature of migration to influence stress levels differently in immigrant women and men with psychotic disorders. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether international normalized ratio (INR), bilirubin, and creatinine predict bleeding risk following percutaneous liver biopsy. Methods: A total of 870 consecutive patients (age 53 ± 14 years; 53% (459/870) male) undergoing non-targeted, ultrasound-guided, percutaneous liver biopsy at a single tertiary center from 01/2016 to 12/2019 were retrospectively reviewed. Results were analyzed using descriptive statistics and logistic regression models to evaluate the relationship between individual and combined laboratory values, and post-biopsy bleeding risk. Receiver operating characteristic (ROC) curves and area under ROC (AUC) curves were constructed to evaluate predictive ability. Results: Post-biopsy bleeding occurred in 2.0% (17/870) of patients, with 0.8% (7/870) requiring intervention. The highest INR within 3 months preceding biopsy demonstrated the best predictive ability for post-biopsy bleeding and was superior to the most recent INR (AUC = 0.79 vs 0.61, p = 0.003). Total bilirubin is an independent predictor of bleeding (AUC = 0.73) and better than the most recent INR (0.61). Multivariate regression analysis of the highest INR and total bilirubin together yielded no improvement in predictive performance compared to INR alone (0.80 vs 0.79). The MELD score calculated using the highest INR (AUC = 0.79) and most recent INR (AUC = 0.74) were similar in their predictive performance. Creatinine is a poor predictor of bleeding (AUC = 0.61). Threshold analyses demonstrate an INR of > 1.8 to have the highest predictive accuracy for bleeding. Conclusion: The highest INR in 3 months preceding ultrasound-guided percutaneous liver biopsy is associated with, and a better predictor for, post-procedural bleeding than the most recent INR and should be considered in patient risk stratification. Clinical relevance statement: Despite correction of coagulopathic indices, the highest international normalized ratio within the 3 months preceding percutaneous liver biopsy is associated with, and a better predictor for, bleeding and should considered in clinical decision-making and determining biopsy approach. Key Points: • Bleeding occurred in 2% of patients following ultrasound-guided liver biopsy, and was non-trivial in 41% of those patients who needed additional intervention and had an associated 23% 30-day mortality rate. • The highest INR within 3 months preceding biopsy (AUC = 0.79) is a better predictor of bleeding than the most recent INR (AUC = 0.61). • The MELD score is associated with post-procedural bleeding, but with variable predictive performance largely driven by its individual laboratory components. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the pattern and trend of Musculoskeletal (MSK) disorders in people aged 5–19 years from 1990 to 2021. The data was sourced from the Global Burden of Disease study 2021. The Age-standardized DALYs rates (ASDR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized incidence rate (ASIR) and their corresponding average annual percent change (AAPC) for MSK disorders were evaluated by sex, region, and sociodemographic index (SDI) quintiles. Globally, the ASPR of MSK disorders among children and adolescents increased per 100,000 population from 3048.66 (95% confidence interval [CI]: 2336.68–3887.02) in 1990 to 3105.46 (95% CI: 2421.09–3904.95) in 2021 (AAPC 0.06 [95% CI: 0.05–0.07]). In 2021, individuals aged 15–19 experienced the highest burden compared to those aged 5–9 and 10–14. In 2021, high SDI countries had the highest ASIR, ASPR, ASDR of MSK disorders. The AAPC of ASPR in high SDI countries showed a stark contrast to that in low SDI countries for the same period (AAPC 0.48 vs. AAPC −0.03). From 1990 to 2021, in low SDI and low-middle SDI countries, the increase in DALYs was primarily due to population growth. However, in middle SDI, high-middle, and high SDI countries, the increases were mainly due to epidemiological changes. Globally, patients aged 10–14 experienced better care compared to those in the 5–9 and 15–19 age groups. Specific preventive health measures are needed for females and adolescents aged 15–19 in high SDI countries. [ABSTRACT FROM AUTHOR]

Pediatric patients with moderate and great complexity congenital heart disease (CHD) may benefit from coordinated transfer to adult congenital heart disease (ACHD) centers to reduce the risk of complications; however, there are a variety of transfer practices. We examined the impact of referral order placement at the last pediatric cardiology visit on time to transfer to an ACHD center. We analyzed data collected from pediatric patients with moderate and great complexity CHD who were eligible to transfer to our tertiary center's accredited ACHD center. We examined transfer outcomes and time-to-transfer between those with a referral order placed at the last pediatric cardiology visit and those without using Cox proportional hazards modeling. The sample (n = 65) was 44.6% female and mean age at study start was 19.5 years (± 2.2). Referral orders were placed for 32.3% of patients at the last pediatric cardiology visit. Those who had a referral order placed at the last visit had significantly higher number of successful transfers to the ACHD center compared to those who did not (95% vs 25%, p < 0.001). In a Cox regression model, placement of a referral order at the last pediatric cardiology visit was associated significantly with a sooner time to transfer (HR 6.0; 95% CI 2.2–16.2, p > 0.001), adjusting for age, sex, complexity, living location, and pediatric cardiology visit location. Placement of a referral order at the last pediatric cardiology visit may improve transfer occurrence and time to transfer to accredited ACHD centers. [ABSTRACT FROM AUTHOR]

Container ports and hinterland manufacturing are two important forces of the local participation in economic globalization. This study, taking the Pearl River Delta (PRD), China with an export-oriented economy as an example, applies Huff and panel regression models to evaluate the impact of hinterland manufacturing on the development of container ports during the period of 1993–2019. The results show that 1) the spatial patterns of hinterlands for hub ports help to determine the distribution range and scale of economic variables that affect port throughput; 2) the hinterland's gross manufacturing output has universally positive influence on port throughput, wherein export-oriented processing and the entire manufacturing industry have significantly positive impact on port throughput in 1993–2011 and 2001–2019, respectively; 3) the two internal structural factors related to an export-oriented economy, labor-intensive sectors and foreign-funded terminals, have positively moderate the direct influence of hinterland manufacturing on port throughput. Our results highlight the importance of local context in understanding port-manufacturing relationship in developing economies. Based on our findings, policy implications are further proposed to enhance port network organization in PRD. [ABSTRACT FROM AUTHOR]

The effect of different feed rations on RAS-based pikeperch juveniles' growth parameters was studied. Juvenile pikeperch were reared in three separate experiments (I, II, and III) at a temperature of 24 °C with initial body weights of the fish at 1.3, 9.4, and 25.6 g, respectively. Four applied feed rations increased by 0.5% in each experiment: 3.0, 3.5, 4.0, and 4.5% of body weight per day (BW day−1) in experiment I; 2.0, 2.5, 3.0, and 3.5% BW day−1 in experiment II; 1.0, 1.5, 2.0, and 2.5% BW day−1 in experiment III. Each experiment in triplicates lasted 28 days. The fish were reared in tanks with working volumes of 1.0 m3 each. All experiments were performed in the same recirculating aquaculture system. The stocking density in experiments I, II, and III was 800, 400, and 200 individuals per tank, respectively. The results of experiment I showed the highest specific growth rate (SGR), weight gain (WG), and biomass gain at the feed ration of 4.5% BW day−1 (P < 0.05). In experiment II, feed ration from 2.5 to 3.5% BW day−1 showed the highest final weight (P < 0.05). In experimental III, feed ration of 2.0 and 2.5% BW day−1 showed the highest final weight, SGR, and WG (P < 0.05). Only in experiment III, based on SGR and WG, second-order polynomial regression showed that the optimal feed ration for pikeperch was 2.35–2.39% BW day−1. [ABSTRACT FROM AUTHOR]

Based on the signaling hypothesis of blood glucose (BG), a rise in BG levels signals a positive energy budget for healthy individuals but cellular starvation for individuals with type 1 diabetes. We examined this novel prediction and its intervention implications in the context of delay discounting, the degree to which delayed rewards are discounted, and the regulatory effects of insulin ingestion. We recruited 44 adults with type 1 diabetes (mean age 30.8 years, diabetes duration 15.4 years) and recorded their BG levels. The delay discounting rate was measured using the intertemporal choice task, where participants were required to choose between sets of smaller-and-sooner (SS) and larger-and-later (LL) rewards. In addition, 82 age-matched healthy participants were recruited to provide a baseline comparison on delay discounting. Random forest analysis showed that among many diagnostic factors, delay discounting was most dominating in differentiating the individuals with type 1 diabetes from the control participants. A hierarchical linear mixed model revealed that participants with type 1 diabetes had a stronger preference for SS rewards (p <.001) after controlling for covariates. Participants who had insulin delivered before the last meal exhibited a stronger preference for LL rewards compared to after-meal delivery. In contrast, subjective measures (e.g., self-reported hunger) failed to predict the participants' actual BG levels and delay discounting rates. In sum, individuals with type 1 diabetes tend to discount future rewards excessively compared to the control participants. Pre-meal insulin ingestion was associated with a higher LL preference for future rewards. [ABSTRACT FROM AUTHOR]

Given the traditional methods of treating obesity through education on controlling eating and increasing exercise have largely failed beyond the very short term, a more intensive focus on psychosocial correlates of those weight-loss behaviors has been suggested. Multiple behavioral theories incorporate self-regulation, self-efficacy, and mood; however, their interrelations and effects over both the short and long term within cognitive-behavioral obesity treatments remain unclear. Within a novel community-based program with women with obesity who had either low (n = 29) or high (n = 71) mood disturbance scores, there were significant improvements in exercise- and eating-related self-regulation and eating-related self-efficacy—primary targets of that intervention—with no significant difference in those changes by mood disturbance grouping. Changes in the summed exercise- and eating-related self-regulation scores significantly mediated relationships between changes in eating-related self-efficacy and weight (over both 6 and 12 months). There were similar results with mediation assessed via the extent exercise-related self-regulation carried over to eating-related self-regulation. In both of those models a reciprocal relationship between self-regulation and self-efficacy changes was indicated. In serial multiple mediation equations, paths of changes in exercise-related self-regulation → eating-related self-regulation → eating-related self-efficacy → weight were significant. However, paths were not significant when change in self-efficacy was entered as the predictor (initial) variable. Findings suggest viability in first focusing on exercise-related self-regulation, then eating-related self-regulation, in the course of increasing self-efficacy and probabilities for inducing enough sustained weight loss to improve obesity-associated health risks. Benefits of field-based research findings generalizing to weight-management applications were suggested. [ABSTRACT FROM AUTHOR]

Childhood adversity is linked to psychological, behavioral, and physical health problems, including obesity and cardiometabolic disease. Epigenetic alterations are one pathway through which the effects of early life stress and adversity might persist into adulthood. Epigenetic mechanisms have also been proposed to explain why cardiometabolic health can vary greatly between individuals with similar Body Mass Index (BMIs). We evaluated two independent cross-sectional cohorts of adults without known medical illness, one of which explicitly recruited individuals with early life stress (ELS) and control participants (n = 195), and the other a general community sample (n = 477). In these cohorts, we examine associations between childhood adversity, epigenetic aging, and metabolic health. Childhood adversity was associated with increased GrimAge Acceleration (GAA) in both cohorts, both utilizing a dichotomous yes/no classification (both p < 0.01) as well as a continuous measure using the Childhood Trauma Questionnaire (CTQ) (both p < 0.05). Further investigation demonstrated that CTQ subscales for physical and sexual abuse (both p < 0.05) were associated with increased GAA in both cohorts, whereas physical and emotional neglect were not. In both cohorts, higher CTQ was also associated with higher BMI and increased insulin resistance (both p < 0.05). Finally, we demonstrate a moderating effect of BMI on the relationship between GAA and insulin resistance where GAA correlated with insulin resistance specifically at higher BMIs. These results, which were largely replicated between two independent cohorts, suggest that interactions between epigenetics, obesity, and metabolic health may be important mechanisms through which childhood adversity contributes to long-term physical and metabolic health effects. [ABSTRACT FROM AUTHOR]

This study examined how single and multiple types of maltreatment allegations differed for young people with child protective services (CPS) only and dual system (i.e., CPS and juvenile delinquency court petition) involvement by gender and race and ethnicity. Allegation types were documented for young people with CPS only or dual system involvement using linked CPS and Probation records for Los Angeles County for a cohort of children born between 1998 and 2001 with a history of at least one CPS maltreatment investigation between birth and age 18. The CPS only and dual system groups were compared using chi-square tests, and a generalized linear model was constructed to assess the relationship between key variables and dual system involvement. Two thirds of young people with dual system involvement (68.2%) experienced two or more allegation types, compared with less than half of young people with CPS involvement only (46.0%). More than three quarters of girls (77.1%) and Black young people (75.3%) with dual system involvement experienced multiple types of maltreatment. 11% of young people with only CPS involvement experienced sexual abuse with another maltreatment type, compared to 22.7% of young people with dual system involvement and 38.6% of girls with dual system involvement.The findings highlight the complex CPS histories of young people with dual system involvement, especially among girls and Black young people. These findings should facilitate discussion of gender-responsive services for young people with traumatic sexual experiences, given the frequency of sexual abuse allegations among girls with dual system involvement. [ABSTRACT FROM AUTHOR]

Purpose: Adolescents in residential treatment (RT) encounter multiple obstacles upon discharge that can make maintaining treatment gains in the community challenging. This study examined relationships among parenting (sense of competence, practices), household chaos, and adolescent behavior problems in a sample of parents with adolescents in RT. Method: This exploratory cross-sectional study used convenience sampling to recruit 71 parents through Facebook. After providing informed consent, parents completed a battery of self-report instruments. Data were analyzed using descriptive statistics and linear regression. Results: Parents reported several strengths, including high involvement and consistent discipline, and low levels of corporal punishment. Parental sense of competence was relatively high, and household chaos was moderate. Adolescent inattention behaviors were positively associated with inconsistent discipline, corporal punishment, and parental sense of competence. Adolescent internalizing behaviors were positively associated with parent involvement and positive parenting and negatively associated with household chaos. Adolescent externalizing behaviors were positively associated with inconsistent discipline, corporal punishment, and parental sense of competence. Discussion: Findings suggest that there are numerous parenting strengths; however, some aspects of parenting could be promoted through evidence-based interventions such as parent training. Future research should also comprehensively study the home environment beyond self-report to understand environmental factors that may promote or inhibit adolescent behavior problems. [ABSTRACT FROM AUTHOR]

Background: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and glomerulonephritis is uncommon in children. We sought to characterize the histological and clinical features of the disease and report on risk factors for adverse outcomes in a pediatric cohort. Methods: Retrospective single-center cohort of all pediatric (< 20 years) patients diagnosed with ANCA-associated glomerulonephritis (AAGN) by kidney biopsy between 2002 and 2022 at Johns Hopkins University. Histological and clinical features were extracted from the medical record. Clinical, laboratory, and histological findings were analyzed to determine the association with kidney failure (KF) and/or death. Results: A total of 17 patients were identified (GPA n = 7, MPA = 10) with a median age of 15 years (IQR 12–17) at presentation, a slight female predominance (59%), with seven patients reaching the composite outcome of death (n = 1) or kidney failure (n = 6). There was no difference in presenting clinical symptoms or extra-renal manifestations between the two groups. Univariable Cox regression identified several factors associated with an increased hazard of endpoint including the degree of global or segmental sclerosis, interstitial fibrosis and tubular atrophy (IFTA), C3 and C1q staining, presence of subendothelial deposits, and proteinuria. Multivariable regression was not performed due to the small sample size. We saw a trend towards increased utilization of plasma exchange and a decrease in cyclophosphamide utilization in the more recent era. There was no association between treatment modality and outcome. Conclusions: Pediatric AAGN is a rare disease associated with significant morbidity. We identified glomerulosclerosis and IFTA on histology, and proteinuria on initial presentation as risk factors for KF/death. [ABSTRACT FROM AUTHOR]

Background: The Schwartz equation is the most widely used serum creatinine (SCr)-based formula to estimate the glomerular filtration rate (GFR) in children of European descent, but whether this applies to African children is unclear. Methods: In a cross-sectional study, 513 apparently healthy African children aged 6 to 16 years were randomly recruited in school area of Kinshasa, the Democratic Republic of Congo (DRC). SCr was measured using calibrated enzymatic method. SCr was normalized using Q-values designed for European descent children, due to the absence of Q-values for African children. Commonly used eGFR equations were applied in this population. Results: Normalization of SCr using Q-values for European descent children was effective in this cohort. The majority of African children (93.4%) have normalized SCr (SCr/Q) values within the reference interval (0.67–1.33) of children of European descent. The bedside-Schwartz equation was associated with significant age and sex dependency. However, the FAS-Age formula showed no sex and age dependency. The new CKiDU25 equation did not show a significant sex dependency. The recently introduced EKFC and LMR18 equations also showed no age and sex dependency, although the distribution of eGFR-values was not symmetrical. On the other hand, the FAS-Height and the Schwartz-Lyon equations showed significant sex dependency but no age dependency. Conclusions: The reference interval for SCr designed for European descent children can be applied to African children. Of all the equations studied, FAS-Age performed best and is most suitable because no height measurements are required. Establishment of specific Q-values for the widespread Jaffe-measured creatinine in Africa can further broaden applicability. [ABSTRACT FROM AUTHOR]

Background: Child care quality rating and improvement systems exist to inform child care decisions and improve the quality of care. While previous research has shown QRIS have effects on quality, less is known about how child care providers vary in engagement and improvement within QRIS. In a voluntary QRIS, it is important to understand how providers vary in motivation, engagement, and progress within the system. Objective: Identify provider characteristics and attitudes that predict QRIS quality advancement. Identify and describe provider subgroups whose rates of quality improvement were different. Method: A random sample of providers (N = 179) and their coaches were interviewed five times over 2 years. The outcome was change in QRIS levels. Predictors were type of care, personal/professional characteristics, QRIS motivation, and coach perceptions of provider motivation and likelihood to advance. Linear regression was used to model change in QRIS level over five time points. Latent profile analysis was used to sort providers into classes. Results: Significant overall predictors of QRIS change were providers' education level and fewer years of experience, and coach's perception of the provider's likelihood to advance. Four subgroups in the latent profile analysis varied by rate of advancement, type of care, education, experience, professional engagement, QRIS motivation, and general readiness to change. Conclusions: Results point to the importance of assessing early and continuing attitudes, engagement, professionalization, and education of participating child care providers. The incentives and needs of providers in most QRIS will vary widely. Technical support geared to provider characteristics will be more effective in improving within QRIS. [ABSTRACT FROM AUTHOR]

Background: The literature suggests that educators can use parent–educator communication to support parents with engaging their children in home learning activities (Epstein, 1995; Hoover-Dempsey & Sandler, 1997). Objective: This study examines the relations between parent–educator communication and preschoolers' numeracy, literacy, executive function, and vocabulary, and explores if the home numeracy environment (HNE) and the home literacy environment (HLE) was a better predictor of children's outcomes than parent–educator communication. Method: Data for this study came from a larger quasi-experimental study evaluating a state-funded preschool program (n = 558). Regression models were run controlling for child's age, sex, race/ethnicity, family income, group, parental education, and baseline skill scores. Results: Analyses revealed a significant relation only between parent–educator communication and numeracy skills (β = − 0.14, p = < 0.001). Unexpectedly, more frequent parent–educator communication in preschool were related to lower numeracy skills. Additionally, there was a statistically significant association between all three predictors- parent-educator communication (β = − 0.15, p = < 0.001), the HNE (β = 0.14, p =.016), and the HLE (β = − 0.18, p =.004)- and children's numeracy skills. Specifically, more frequent parent–educator communication and higher HLE scores in preschool predicted lower numeracy skills. Additionally, the higher quality of the HNE predicted greater numeracy skills in the spring of preschool. Conclusion: There may be increased communication when the children are performing lower on their numeracy skills than their peers and teachers and parents are working to remediate those challenges. [ABSTRACT FROM AUTHOR]