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Background: Cardiovascular disease is the leading cause of death among women in the United States. Past research has highlighted the importance of the relationship between female-specific demographics and traditional risk factors. The present analysis aimed to identify the prevalence of modifiable risk factors in women attending a community cardiovascular health screening. Methods: Data collected between 2011 and 2019 were obtained from the Houston HeartReach Registry. Participants were classified as having or not having each of 4 traditional cardiometabolic risk factors: hypertension, diabetes, body mass index indicating overweight or obesity, and dyslipidemia. Differences in prevalence were compared using the Pearson χ2 test. Results: Most participants had hypertension, overweight or obesity, and dyslipidemia. Older women (≥65 years) had the highest prevalence of all cardiometabolic risk factors. Black participants had a higher prevalence of hypertension (P = .006) and a lower prevalence of dyslipidemia (P = .009) than non-Black participants. Hispanic participants had a lower prevalence of hypertension (P < .001) and a higher prevalence of overweight or obesity (P = .03) than non-Hispanic participants. Participants in the lowest household income bracket (

Abstract Background Excess muscle fat is observed in obesity and associated with greater burden of cardiovascular risk factors and higher risk of mortality. Liraglutide reduces total body weight and visceral fat but its effect on muscle fat and adverse muscle composition is unknown. Methods This is a pre‐specified secondary analysis of a randomized, double‐blind, placebo‐controlled trial that examined the effects of liraglutide plus a lifestyle intervention on visceral adipose tissue and ectopic fat among adults without diabetes with body mass index ≥30 kg/m2 or ≥27 kg/m2 and metabolic syndrome. Participants were randomly assigned to a once‐daily subcutaneous injection of liraglutide (target dose 3.0 mg) or matching placebo for 40 weeks. Body fat distribution and muscle composition was assessed by magnetic resonance imaging at baseline and 40‐week follow‐up. Muscle composition was described by the combination of thigh muscle fat and muscle volume. Treatment difference (95% confidence intervals [CI]) was calculated by least‐square means adjusted for baseline thigh muscle fat. The association between changes in thigh muscle fat and changes in body weight were assessed using Spearman correlation coefficients. The effect of liraglutide versus placebo on adverse muscle composition, denoted by high thigh muscle fat and low thigh muscle volume, was explored. Results Among the 128 participants with follow‐up imaging (92.2% women, 36.7% Black), median muscle fat at baseline was 7.8%. The mean percent change in thigh muscle fat over median follow‐up of 36 weeks was −2.87% among participants randomized to liraglutide (n = 73) and 0.05% in the placebo group (absolute change: −0.23% vs. 0.01%). The estimated treatment difference adjusted for baseline thigh muscle fat was −0.24% (95% CI, −0.41 to −0.06, P‐value 0.009). Longitudinal change in thigh muscle fat was significantly associated with change in body weight in the placebo group but not the liraglutide group. The proportion of participants with adverse muscle composition decreased from 11.0% to 8.2% over follow‐up with liraglutide, but there was no change with placebo. Conclusions In a cohort of predominantly women with overweight or obesity in the absence of diabetes, once‐daily subcutaneous liraglutide was associated with a reduction in thigh muscle fat and adverse muscle composition compared with placebo. The contribution of muscle fat improvement to the cardiometabolic benefits of liraglutide requires further study.

Abstract Ficus species (Moraceae) play pivotal roles in tropical and subtropical ecosystems. Thriving across diverse habitats, from rainforests to deserts, they harbor a multitude of mutualistic and antagonistic interactions with insects, nematodes, and pathogens. Despite their ecological significance, knowledge about the genomic background of Ficus remains limited. In this study, we report a chromosome-level reference genome of F. hirta, with a total size of 297.27 Mb, containing 28,625 protein-coding genes and 44.67% repeat sequences. These findings illuminate the genetic basis of Ficus responses to environmental challenges, offering valuable genomic resources for understanding genome size, adaptive evolution, and co-evolution with natural enemies and mutualists within the genus.

Patients with type 2 diabetes face an elevated risk of cardiovascular disease. This review centers on sodium-glucose cotransporter-2 (SGLT2) inhibitors, a class of drugs that, according to a growing body of evidence, may have major potential for managing cardiovascular disease in patients with type 2 diabetes. This review presents findings from multiple clinical trials suggesting that SGLT2 inhibitors can not only serve as preventive therapeutic agents but also play a role in the active management of heart failure. The discussion includes the mechanism of action of SGLT2 inhibitors, emphasizing that they enhance urinary glucose excretion, which could lead to improved glycemic control and contribute to metabolic shifts beneficial to cardiac function. Alongside these cardiometabolic effects, safety concerns and practical considerations for prescribing these agents are addressed, taking into account potential adverse effects such as genitourinary infections and diabetic ketoacidosis as well as the financial implications for patients. Despite these drawbacks, therapeutic indications for SGLT2 inhibitors continue to expand, including for kidney protection, although further research is necessary to fully understand the mechanisms driving the cardioprotective and kidney-protective effects of SGLT2 inhibitors. By synthesizing current knowledge, this review intends to inform and guide clinical decision-making, thereby enhancing cardiovascular disease outcomes in patients with type 2 diabetes.

Supply chain management is the systematic, strategic coordination of business tasks engaged in a supply chain to enhance a company's and a supplier chain's overall long-term performance. It is also a set of approaches used effectively to integrate suppliers, manufacturers, distributors, or customers to improve the long-term performance of the companies involved and the supply chain itself as a whole. A lack of financial resources is the main obstacle to supply chain management development. This study intends to investigate the mediating effect of customer loyalty on the relationships among supply chain performance, inventory management, and quality management. An electronic manufacturing facility in Penang, Malaysia, served as the site of this investigation. Consequently, 700 individuals were working at this industrial company. This industrial company's employees were given the questionnaire, which was created. An analysis of the relationship and effects of quality management, inventory management, supply chain management, and customer loyalty on the performance of the product market was performed via nonprobability sampling on a population of 700 employees to generate a sample of 65 respondents based on the PLS-SEM. Several statistical methods were employed in this study, and SMART PLS3 was utilised to analyse the data. The effectiveness of a product in the market was found to be significantly influenced by variables such as customer loyalty, inventory management, supply chain management, and product market performance. The results showed that seven hypotheses had significant connections for all variables. Business owners and other relevant stakeholders are suggested to improve the supply chain, inventory management, and quality management systems in their organisation's business operations to promote customer loyalty and product market performance for long-term viability. The effort continued during the RMK-9 period by implementing comprehensive policy because more intense competition had to be faced by the industry, including SMEs, due to the existence of globalisation and trade liberalisation.

Abstract Background With 11,558 deaths and 200,000 suicide attempts in 2019, France is among the European countries most affected. The aim of this study was to determine the costs and burden of suicides and suicide attempts in France (population 67 million). Methods We estimated direct costs, comprising healthcare, as well as post-mortem costs including autopsy, body removal, funeral expenses, police intervention and support groups; indirect costs comprised lost productivity, daily allowances; the burden of disease calculations used a monetary value for death and disability based on incidence data. Data was obtained from the national statistics, health and social care database, registries, global burden of disease, supplemented by expert opinion. We combined top down and bottom up approaches. Results The total costs and burden of suicides and suicide attempts was estimated at €18.5 billion and €5.4 billion, respectively. Direct costs were €566 million and €75 million; indirect costs were €3.8 billion and €3.5 billion; monetary value for death and disability was €14.6 billion and €1.3. The monetary value for death and disability represented 79.1% and 24.8% of total costs for suicide and suicide attempt respectively. Some costs were based upon expert opinion, caregivers’ burden was not counted and pre COVID data only is reported. Conclusions In France, the total cost and burden of suicides and suicide attempts was several billion €, suggesting major potential savings from public health interventions.

Abstract Dipterocarpoideae species form the emergent layer of Asian rainforests. They are the indicator species for Asian rainforest distribution, but they are severely threatened. Here, to understand their adaptation and population decline, we assemble high-quality genomes of seven Dipterocarpoideae species including two autotetraploid species. We estimate the divergence time between Dipterocarpoideae and Malvaceae and within Dipterocarpoideae to be 108.2 (97.8‒118.2) and 88.4 (77.7‒102.9) million years ago, and we identify a whole genome duplication event preceding dipterocarp lineage diversification. We find several genes that showed a signature of selection, likely associated with the adaptation to Asian rainforests. By resequencing of two endangered species, we detect an expansion of effective population size after the last glacial period and a recent sharp decline coinciding with the history of local human activities. Our findings contribute to understanding the diversification and adaptation of dipterocarps and highlight anthropogenic disturbances as a major factor in their endangered status.

Abstract Although studies of insect decline have recently dominated headlines worldwide, their interpretation requires caution since for most species, we lack long‐term population baselines. In the tropics, where most insect species thrive, our knowledge is even more limited and so reliable insect assessments must originate from well‐established long‐term monitoring efforts. Combining the extensive monitoring data from the Arthropod Program of the Smithsonian Tropical Research Institute (STRI) on Barro Colorado Island (BCI), Panama, we compare whether known arthropod diversity can be detected through metabarcoding of bulk insect samples obtained through automatic light‐trapping. Our study detected 4402 species based on Barcode Index Numbers (BIN) and detected fine‐scale differences between wet and dry seasons and sampling localities. We further refined our analysis to indicate which families and genera explained seasonal turnover. Using samples collected in parallel, but sorted manually as part of the ongoing arthropod monitoring program, we compared these methods. Out of 538 BINs recovered through manual sorting, there was a 70% overlap with the metabarcoding data; however, it represented 30% of the total BINs detected through metabarcoding. Expecting higher detection through metabarcoding, we also compare the results with the 14 years of sampling in BCI to better understand how well the monitoring program has captured the diversity of focal groups. Our results revealed a ~50% overlap between both methods and similar total catch. Barcode Index Numbers manually detected but not recovered by metabarcoding highlight some of the limitations of molecular detection methods such as primer bias. Contrastingly, BINs detected with metabarcoding, but not recovered by the traditional monitoring scheme, highlight the importance of local and regional barcode reference libraries.

OBJECTIVES: In this study, we sought to evaluate the association of frailty with the use of optimal guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF). BACKGROUND: The burden of frailty in HFrEF is high, and the patterns of GDMT use according to frailty status have not been studied previously. METHODS: A post hoc analysis of patients with HFrEF enrolled in the GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial was conducted. Frailty was assessed with the use of a frailty index (FI) using a 38-variable deficit model, and participants were categorized into 3 groups: class 1: nonfrail, FI 0.31). Multivariate-adjusted Cox models were used to study the association of frailty status with clinical outcomes. Use of optimal GDMT over time (beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists) across frailty strata was assessed with the use of adjusted linear and logistic mixed-effect models. RESULTS: The study included 879 participants, of which 56.3% had high frailty burden (class 3 FI). A higher frailty burden was associated with a significantly higher risk of HF hospitalization or death in adjusted Cox models: high frailty vs nonfrail HR: 1.76, 95% CI: 1.20-2.58. On follow-up, participants with high frailty burden also had a significantly lower likelihood of achieving optimal GDMT: high frailty vs non-frail GDMT triple therapy use at study end: 17.7% vs 28.4%; P interaction, frailty class × time

AIMS: To evaluate the performance of the WATCH-DM risk score, a clinical risk score for heart failure (HF), in patients with dysglycaemia and in combination with natriuretic peptides (NPs). METHODS AND RESULTS: Adults with diabetes/pre-diabetes free of HF at baseline from four cohort studies (ARIC, CHS, FHS, and MESA) were included. The machine learning- [WATCH-DM(ml)] and integer-based [WATCH-DM(i)] scores were used to estimate the 5-year risk of incident HF. Discrimination was assessed by Harrells concordance index (C-index) and calibration by the Greenwood-Nam-DAgostino (GND) statistic. Improvement in model performance with the addition of NP levels was assessed by C-index and continuous net reclassification improvement (NRI). Of the 8938 participants included, 3554 (39.8%) had diabetes and 432 (4.8%) developed HF within 5 years. The WATCH-DM(ml) and WATCH-DM(i) scores demonstrated high discrimination for predicting HF risk among individuals with dysglycaemia (C-indices = 0.80 and 0.71, respectively), with no evidence of miscalibration (GND P ≥0.10). The C-index of elevated NP levels alone for predicting incident HF among individuals with dysglycaemia was significantly higher among participants with low/intermediate (

BackgroundA wide array of existing instruments are commonly used to assess childhood behavior and development for the evaluation of social, emotional and behavioral disorders such as Autism Spectrum Disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and anxiety. Many of these instruments either focus on one diagnostic category or encompass a broad set of childhood behaviors. We analyze a wide range of standardized behavioral instruments and identify a comprehensive, structured semantic hierarchical grouping of child behavioral observational features. We use the hierarchy to create Rosetta: a new set of behavioral assessment questions, designed to be minimal yet comprehensive in its coverage of clinically relevant behaviors. We maintain a full mapping from every functional feature in every covered instrument to a corresponding question in Rosetta.ResultsIn all, 209 Rosetta questions are shown to cover all the behavioral concepts targeted in the eight existing standardized instruments.ConclusionThe resulting hierarchy can be used to create more concise instruments across various ages and conditions, as well as create more robust overlapping datasets for both clinical and research use.

Abstract Conservation gardening (CG) represents a socio-ecological approach to address the decline of native plant species and transform the gardening industry into an innovative conservation tool. However, essential information regarding amenable plants, their ecological requirements for gardening, and commercial availability remains limited and not readily available. In this study, we present a workflow using Germany as a case study to bridge this knowledge gap. We synthesized the Red Lists of all 16 federal states in Germany, and text-mined a comprehensive platform for garden plants, as well as multiple German producers of native plants. To provide accessible information, we developed a user-friendly app ( https://conservation-gardening.shinyapps.io/app-en/ ) that offers region-specific lists of CG plants, along with practical guidance for planting and purchasing. Our findings reveal that a median of 845 plant species are red-listed across federal states (ranging from 515 to 1123), with 41% of these species amenable to gardening (ranging from 29 to 53%), resulting in a total of 988 CG species. Notably, 66% of these species (650) are already available for purchase. Additionally, we observed that many CG plants exhibit drought tolerance and require less fertilizer on average, with implications for long-term urban planning and climate adaptation. Collaborating with gardening experts, we present a selection of purchasable CG balcony plants for each federal state, highlighting the feasibility of CG even for individuals without gardens. With a multitude of declining plants amenable to gardening and the vital role of gardens as refuges and green corridors, CG holds substantial potential to catalyze transformative change in bending the curve of biodiversity loss.

Recent reports show how Malaysians are increasingly turning to digital channels for purchasing and making decisions. However, some issues that arise in different digital marketing channels, including email marketing, search engine marketing, and social media marketing, can lead to negative consequences such as email overload, misinterpretation of search results, and the spread of false or offensive content. The study aimed to examine the impact of email marketing, search engine marketing (SEM), and social media marketing on consumer buying decisions. The study used a quantitative method, with 384 respondents from the region Johor, Malaysia, surveyed using convenience sampling. The results of the study indicated that email marketing has a negative relationship with consumer buying decisions, whereas search engine marketing and social media marketing have a positive relationship with consumer buying decisions. Therefore, the study recommends that marketers focus on digital marketing channels such as search engines and social media marketing to improve their marketing efficiency since they have a more significant impact on consumer buying decisions compared to email marketing.

Abstract Polyphagous insect herbivores feed on multiple host‐plant species and face a highly variable chemical landscape. Comparative studies of polyphagous herbivore metabolism across a range of plants is an ideal approach for exploring how intra‐ and interspecific chemical variation shapes species interactions. We used polyphagous caterpillars of Lymantria mathura (Erebidae, Lepidoptera) to explore mechanisms that may contribute to its ability to feed on various hosts. We focused on intraspecific variation in polyphenol metabolism, the fates of individual polyphenols, and the role of previous feeding experience on polyphenol metabolism and leaf consumption. We collected the caterpillars from Acer amoenum (Sapindaceae), Carpinus cordata (Betulaceae), and Quercus crispula (Fagaceae). We first fed the larvae with the leaves of their original host and characterized the polyphenol profiles in leaves and frass. We then transferred a subset of larvae to a different host species and quantified how host shifting affected their leaf consumption and polyphenol metabolism. There was high intraspecific variation in frass composition, even among caterpillars fed with one host. While polyphenols had various fates when ingested by the caterpillars, most of them were passively excreted. When we transferred the caterpillars to a new host, their previous experience influenced how they metabolized polyphenols. The one‐host larvae metabolized a larger quantity of ingested polyphenols than two‐host caterpillars. Some of these metabolites could have been sequestered, others were probably activated in the gut. One‐host caterpillars retained more of the ingested leaf biomass than transferred caterpillars. The pronounced intraspecific variation in polyphenol metabolism, an ability to excrete ingested metabolites and potential dietary habituation are factors that may contribute to the ability of L. mathura to feed across multiple hosts. Further comparative studies can help identify if these mechanisms are related to differential host‐choice and response to host‐plant traits in specialist and generalist insect herbivores.

Abstract Species richness has been shown to decrease, and elevational range increase (the Rapoport effect), with elevation as a consequence of biotic and abiotic factors, but patterns are inconsistent across taxonomic groups. Despite being an important indicator taxon and a component of local communities, Orthoptera distributions at higher elevations in Europe remain unclear. We investigated the relationship of Orthoptera species richness and elevational range with elevation in the Pyrenees mountains, Europe. We conducted sweepnetting surveys supplemented by hand‐sampling, at 28 sites stratified by elevation, across three study areas. Using generalised linear models, we found that species richness declined with elevation. Elevation was an important predictor of species richness, but sampling effort and vegetation structure (height and cover) also contributed to estimates of species richness. Using a nonlinear regression to model the elevational range of species over the elevational gradient, we did not observe a Rapoport effect, with elevational range peaking at mid‐elevation instead. Smaller elevational ranges of species found at high elevations may be due to a combination of sampling over a restricted elevational range and the presence of specialist high‐elevation species. We argue that our findings are useful for understanding species distributions with elevation at the interface between local and regional scales. Clarifying the biotic and abiotic predictors of species distribution is important for informing conservation efforts and predicting consequences of climate change.

We use community phylogenetics to elucidate the community assembly mechanisms for Geometridae moths (Lepidoptera) collected along a complete rainforest elevational gradient (200-3700 m a.s.l) on Mount Wilhelm in Papua New Guinea. A constrained phylogeny based on COI barcodes for 604 species was used to analyse 1390 species x elevation occurrences at eight elevational sites separated by 500 m elevation increments. We obtained Nearest Relatedness Index (NRI), Nearest Taxon Index (NTI) and Standardised Effect Size of Faith's Phylogenetic Diversity (SES.PD) and regressed these on temperature, plant species richness and predator abundance as key abiotic and biotic predictors. We also quantified beta diversity in the moth communities between elevations using the Phylogenetic Sorensen index. Overall, geometrid communities exhibited phylogenetic clustering, suggesting environmental filters, particularly at higher elevations at and above 2200 m a.s.l and no evidence of overdispersion. NRI, NTI and SES.PD showed no consistent trends with elevation or the studied biotic and abiotic variables. Change in community structure was driven by turnover of phylogenetic beta-diversity, except for the highest 2700-3200 m elevations, which were characterised by nested subsets of lower elevation communities. Overall, the elevational signal of geometrid phylogeny was weak-moderate. Additional insect community phylogeny studies are needed to understand this pattern.

The majority of multi-cellular terrestrial life is found in tropical forests and is either an invertebrate or a plant: for decades ecologists have sought to understand why. As global change erodes the list of extant species on our planet quantifying what species remain, along with their origins and ecology, contributes to our ability to preserve ecosystem functioning and resilience. Here we study three feeding guilds of caterpillars (Lepidoptera) and seek to understand the drivers of their diet breadth across four diverse tropical plant genera in Papua New Guinea. Host specificity is central to biodiversity estimates and the resilience of ecological networks. Specifically, we calculate distance-based host specificity in relation to plant phylogenetic relationships alongside chemical and mechanical traits of leaves. In terms of chemical defenses, we focus on the major polyphenol groups, a compound class shared across many plant species. We refine our data exploration using food webs and ordinations to pick out specific traits of relevance to insect host specificity. Our results showed that the degree of specialization for caterpillars took the following order: phylogenetic>polyphenol>mechanical, such that insect specificity was explained best by host phylogeny and polyphenol chemistry in our study system. Leaf mining insects had higher host specificity than those feeding externally. Of the traits studied hexahydroxydiphenoyl derivatives, galloyl derivatives, trichome density, quinic acid derivatives, myricetins and successional index explained the most variation in overall insect community structure. Our findings build on earlier studies of New Guinean rainforest communities and add a mechanistic explanation to previous findings that host genera are functional islands for insect herbivores. Further, we demonstrate that different plant genera combine different defensive traits that appear to drive associated insect diversity. Our approach integrates trait data and phylogeny to explore dimensions of specialization and we welcome metabolomic studies that will provide more detailed explanations for insect-herbivore host use. Finally, chemical diversity is directly linked to organismal diversity and by studying a range of insect herbivore guilds we make a connection between feeding ecology and specialization that will help to predict species interactions and, potentially, the persistence of ecological networks.