Additional Adjustment Research Articles

A Noisy Sample Selection Framework Based on a Mixup Loss and Recalibration Strategy

Deep neural networks (DNNs) have achieved breakthrough progress in various fields, largely owing to the support of large-scale datasets with manually annotated labels. However, obtaining such datasets is costly and time-consuming, making high-quality annotation a challenging task. In this work, we propose an improved noisy sample selection method, termed “sample selection framework,” based on a mixup loss and recalibration strategy (SMR). This framework enhances the robustness and generalization abilities of models. First, we introduce a robust mixup loss function to pre-train two models with identical structures separately. This approach avoids additional hyperparameter adjustments and reduces the need for prior knowledge of noise types. Additionally, we use a Gaussian Mixture Model (GMM) to divide the entire training set into labeled and unlabeled subsets, followed by robust training using semi-supervised learning (SSL) techniques. Furthermore, we propose a recalibration strategy based on cross-entropy (CE) loss to prevent the models from converging to local optima during the SSL process, thus further improving performance. Ablation experiments on CIFAR-10 with 50% symmetric noise and 40% asymmetric noise demonstrate that the two modules introduced in this paper improve the accuracy of the baseline (i.e., DivideMix) by 1.5% and 0.5%, respectively. Moreover, the experimental results on multiple benchmark datasets demonstrate that our proposed method effectively mitigates the impact of noisy labels and significantly enhances the performance of DNNs on noisy datasets. For instance, on the WebVision dataset, our method improves the top-1 accuracy by 0.7% and 2.4% compared to the baseline method.

Association Between Physical Activity Levels and Cognitive Function in Older Adults: A Replication Cohort Analysis Using the Brazilian Longitudinal Study of Aging

Introduction: Few studies address the complex relationship between physical activity and cognitive function in aging individuals. This topic has gained significant attention in recent years, as cognitive decline poses a substantial public health challenge. There is a lack of research focusing on the effect of physical activity on cognitive function in the Brazilian population. Purpose: Our study aims to replicate the findings of Lautenschlager et al. using a Brazilian cohort from the ELSI study, a comprehensive longitudinal study capturing aging processes and determinants among individuals in Brazil. Method: In line with the reference study, our analysis focused on individuals aged 50 and older without depression and dementia. The primary outcome was cognitive function, assessed using a summary score obtained from the ELSI study to replicate the ADAS-Cog, as in the original study. Participants were categorized into two groups: those engaging in moderate to vigorous exercise (exercise) and those who did not meet this exercise threshold (no exercise). To evaluate the relationship between exercise and cognitive function, we performed three linear regression models: one without adjustments for covariates, a second model adjusting for sex, education, and race (main model), and a third model with multiple adjustments. A sensitivity analysis using Cohen's D was also conducted. Results: In this study from the ELSI cohort, data from 7,292 individuals were available, and 6,147 met the inclusion criteria for analysis. A total of 935 individuals were excluded due to depression, and 98 were excluded due to dementia. Baseline characteristics were not well balanced between groups. The mean age in the exercise group was 64 years compared to 67 years in the no exercise group, with a higher percentage of males (48% vs. 39%) and a higher education level (12% with university education vs. 6%). In the unadjusted linear regression, there was a positive correlation between exercise and cognitive function (2.19, 95% CI 1.89-2.48, p<0.001). In the second model, which emulated the reference trial by including sex, race, and educational status, the positive correlation persisted, though with a lower effect size (1.53, 95% CI 1.25-1.82, p<0.001). A third model with additional adjustments was employed to assess the consistency of the association, which was maintained (1.92, 95% CI 1.62-2.23, p<0.001). Conclusion: Our study reaffirms the potential benefits of moderate to vigorous exercise on cognitive function in older adults with mild cognitive impairment.

Benchmark DEBORA: Assessment of MCFD compared to high-pressure boiling pipe flow measurements

A benchmark activity on two-fluid simulations of high-pressure boiling upward flows in a pipe is performed by 12 participants using different MCFD (Multiphase Computational Fluid Dynamics) codes and closure relationships. More than 30 conditions from DEBORA experiment conducted by CEA are considered. Each case is characterised by the flow rate, inlet temperature, wall heat flux and outlet pressure. High-pressure Freon (R12) at 14bar and 26bar is boiled in a 19.2mm pipe heated over 3.5m. Flow rates range from 2000kgm−2s−1 to 5000kgm−2s−1 and exit quality x ranges from single-phase conditions to x=0.1 which leads to a peak void fraction of α=70%. In these high pressure conditions, bubbles remain small and there is no departure from the bubbly flow regime (François et al., 2011; Hösler, 1968). However, different kind of bubbly flows are observed: wall-peak, intermediate peak or core-peak, depending on the case considered. Measurements along the pipe radius near the end of the heated section are compared to code predictions. They include void fraction, bubble mean diameter, vapour velocity and liquid temperature. The benchmark covered two phases. In the first phase of the benchmark activities, experimental data were given to the participants, allowing to compare the simulation results and to develop, to select or to adjust the models in the CMFD codes. The second phase included blind cases where the participants could not compare to the measurements. In between the two phases, possible additional model adjustments or calibrations were performed.Overall, the benchmark involved very different closures and a wide range of models’ complexity was covered. Yet, it is extremely difficult to have a robust closure for all conditions considered, even knowing experimental measurements. The wall-to-core peak transition is not captured consistently by the models. The degree of subcooling and the void fraction level are also difficult to assess. We were not capable of showing superiority of some physical closures, even for part of the model. The interaction between mechanisms and their hierarchy are extremely difficult to understand.Although departure from nucleate boiling (DNB) was not considered in this benchmarking exercise, it is expected that DNB predictions at high-pressure conditions depend strongly on the near-wall flow, temperature, and void fraction distributions. Therefore, the suitability of the closures also limits the accuracy of DNB predictions. The benchmark also demonstrated that in order to progress further in models development and validation, it is compulsory to have new measurements that include simultaneously as many variables as possible (including liquid temperature, velocity, cross-correlations and wall temperature); also, a better knowledge of the local bubble sizes distributions is the key to discriminate performances of interfacial area modelling (IATE, MUSIG or iMUSIG models, considering for instance the possibility of two classes of bubbles having totally different behaviour regarding the lift force).Following this benchmark impulse, we hope that future activities will be engaged on high-pressure boiling water experiments with a continuation of models’ comparisons and development.

Sleep duration irregularity and risk for incident cardiovascular disease in the UK Biobank.

Emerging evidence supports a link between circadian disruption as measured by higher night-to-night variation in sleep duration and increased risk of cardiovascular disease (CVD). It remains unclear whether this association varies by CVD types or may be modified by average sleep duration and genetic risk for CVD. Our prospective analysis included 86,219 UK Biobank participants who were free from CVD when completing 7 days of accelerometer measurement in 2013-2016. Sleep irregularity was evaluated by the standard deviation (SD) of accelerometer-measured sleep duration over 7 days. Incident major CVD events, defined as fatal or nonfatal myocardial infarction (MI) and stroke, were identified through linkage to Hospital Episode Statistics data until May 31, 2022. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs for associations of sleep duration SD with risk for major CVD events overall and for MI and stroke separately. We documented 2,310 incident cases of major CVD events (MI: 1,183, stroke: 1,175) over 636,258 person-years of follow-up. After adjusting for sociodemographic factors and family history of CVD, the HR (95% CI) associated with a 1-hour increase in sleep duration SD was 1.19 (1.10, 1.27) for CVD (p-trend<0.0001), 1.23 (1.11, 1.35) for MI (p-trend<0.0001), and 1.17 (1.05, 1.29) for stroke (p-trend=0.003). Additional adjustment for lifestyle factors, co-morbidities and sleep-related factors modestly attenuated these associations. Higher sleep irregularity was associated with higher CVD risk irrespective of genetic risk (p-interaction=0.43), but this association was stronger among individuals with longer average sleep duration >8 hours (p-interaction=0.006). Higher night-to-night variation in accelerometer-measured sleep duration was associated with consistently higher risks for major CVD events. The association did not seem to be modified by genetic risk for CVD and was more pronounced in long sleepers.

A compensation method for PMSM sensorless control with parameter identification considering SMO observation error

AbstractSensorless control of permanent magnet synchronous motor (PMSM) can increase the reliability of electric actuators of more electrical aircraft. Numerical online parameter estimation method will enhance the performance for sensorless control methods based on sliding mode observer (SMO). However, numerical online parameter identification methods typically assume zero rotor position estimation error to ensure full rank of the identification equation set. This assumption actually leads to errors in parameter identification, resulting in steady‐state errors in rotor position estimation. This paper focuses on a compensation method for PMSM online parameter identification that takes into account rotor position estimation error. This method is used for sensorless control based on SMO, using model reference adaptive systems for online parameter identification, and no additional parameter adjustment required. Validation is conducted on a PMSM experimental platform with maximum load of 15kW. The experimental results of 1000 r/min steady state operation proved the effectiveness of the method, and the dynamic experiments with 5 and 15kW loads proved that the method has no significant adverse effect on the system dynamics.

The Role of Human-Robot Interaction in Enhancing Efficiency and Safety in Industrial Robotics

This study examines the role of human-robot interaction (HRI) in enhancing efficiency and safety in industrial robotics. Emphasize the importance of efficiency and safety in industrial robotics, underscoring the critical role in improving productivity, reducing costs, and ensuring the well-being of workers. The results were analyzed inline with the four basic robot tasks' completion time. The error rates, collision risks, ergonomic strain, and overall productivity were determined. From the evaluation of the time required to complete each task in the context of human-robot interaction and optimize the workflow to enhance productivity and safety, it was observed that the average task completion time for task 1 was 10.63 minutes; while task 4 was 16.39 minutes. This indicates that some critical tasks require additional resources or adjustments to streamline the process and improve overall performance. In the determination of the safety rating, for each task by subtracting the error rate from 100% performance, it was observed that task 2 has a safety rating of 98% while task 3 has a safety rating of 92%, this indicates that the safety rating is different with respect to a different task. The productivity metrics for each task were determined by multiplying the task completion rate by the task efficiency rate. Hence, the Average Productivity Rating was 0.7449 which indicate the overall productivity in the role of human-robot interaction in enhancing efficiency and safety in industrial robotics. The integration of human-robot interaction in industrial robotics offers a synergistic approach to improving efficiency and safety in manufacturing environments.

Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival?

ObjectiveAcute myeloid leukaemia (AML) prognosis is enhanced with intensive remission induction chemotherapy (ICT) in eligible patients. However, ICT eligibility perceptions may differ among healthcare professionals. This nationwide, population-based study aimed...

Artificial Intelligence-Based Electrocardiographic Biomarker for Outcome Prediction in Patients With Acute Heart Failure: Prospective Cohort Study.

Although several biomarkers exist for patients with heart failure (HF), their use in routine clinical practice is often constrained by high costs and limited availability. We examined the utility of an artificial intelligence (AI) algorithm that analyzes printed electrocardiograms (ECGs) for outcome prediction in patients with acute HF. We retrospectively analyzed prospectively collected data of patients with acute HF at two tertiary centers in Korea. Baseline ECGs were analyzed using a deep-learning system called Quantitative ECG (QCG), which was trained to detect several urgent clinical conditions, including shock, cardiac arrest, and reduced left ventricular ejection fraction (LVEF). Among the 1254 patients enrolled, in-hospital cardiac death occurred in 53 (4.2%) patients, and the QCG score for critical events (QCG-Critical) was significantly higher in these patients than in survivors (mean 0.57, SD 0.23 vs mean 0.29, SD 0.20; P<.001). The QCG-Critical score was an independent predictor of in-hospital cardiac death after adjustment for age, sex, comorbidities, HF etiology/type, atrial fibrillation, and QRS widening (adjusted odds ratio [OR] 1.68, 95% CI 1.47-1.92 per 0.1 increase; P<.001), and remained a significant predictor after additional adjustments for echocardiographic LVEF and N-terminal prohormone of brain natriuretic peptide level (adjusted OR 1.59, 95% CI 1.36-1.87 per 0.1 increase; P<.001). During long-term follow-up, patients with higher QCG-Critical scores (>0.5) had higher mortality rates than those with low QCG-Critical scores (<0.25) (adjusted hazard ratio 2.69, 95% CI 2.14-3.38; P<.001). Predicting outcomes in patients with acute HF using the QCG-Critical score is feasible, indicating that this AI-based ECG score may be a novel biomarker for these patients. ClinicalTrials.gov NCT01389843; https://clinicaltrials.gov/study/NCT01389843.

Do rheumatic diseases, long-term glucocorticoids, and immunosuppressant treatment, and vaccination impact the COVID-19 severity? Insight from a retrospective cohort study.

The impact of rheumatic diseases, long-term medication, and vaccination on COVID-19 severity remain insufficiently understood, hindering effective patient management. This study aims to investigate factors influencing COVID-19 severity in Chinese rheumatic patients and to provide real-world evidence for patient care. We conducted a retrospective observational study consisting of two cohorts, followed by a nested case-control analysis. The outpatient cohort included non-severe COVID-19 patients, while the inpatient cohort included consecutive severe COVID-19 inpatients. Additionally, rheumatic patients from both cohorts were included for the nested case-control study. Clinical information was obtained from electronic medical records and surveys. A total of 749 outpatients and 167 inpatients were enrolled. In the outpatient cohort, rheumatic diseases were identified as a risk factor for the severity of dyspnea (No rheumatic disease: OR = 0.577, 95% CI = 0.396-0.841, p = .004), but not for mortality, length of hospitalization, or hospitalization costs in the inpatient cohort. Long-term glucocorticoids use was identified as an independent risk factor for severity of dyspnea in rheumatic patients (OR = 1.814, 95% CI = 1.235-2.663, p = .002), while vaccination and immunosuppressant treatment showed no association. Vaccination was identified as a protective factor against hospitalization due to COVID-19 in patients with rheumatic diseases (OR = 0.031, 95% CI = 0.007-0.136, p < .001), whereas long-term glucocorticoids and immunosuppressant treatment showed no association. Rheumatic diseases and long-term glucocorticoids use are significant risk factors for COVID-19 severity in the Chinese population, whereas emphasizing the protective effects of vaccines against COVID-19 severity is crucial. Additionally, the investigation provides preliminary support for the concept that long-term immunosuppressant therapy does not necessarily require additional prescription adjustments.

Association of maternal body mass index and gestational weight gain rate with cardiometabolic traits in childhood: A prospective cohort study

Background and aimsEvidence on the association of maternal obesity with offspring cardiometabolic health is limited, particularly for the Asian population. We aimed to examine the associations of maternal body mass index (BMI) in early pregnancy and gestational weight gain (GWG) rate in mid- and late-pregnancy with childhood cardiometabolic traits. Methods and resultsWe used data of 1452 mother-child pairs from a population-based prospective cohort study in China. Maternal BMI in early pregnancy and GWG rate in mid- and late-pregnancy were calculated. Childhood cardiometabolic traits were assessed at aged 4–7 years, including BMI, BMI-z, systolic blood pressure (SBP), diastolic blood pressure, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, total cholesterol, triglycerides, fasting glucose, and C-reactive protein. Each 1 kg/m2 increase in maternal BMI in early pregnancy was associated with 0.46% (95% confidence interval, 0.19%–0.72%) higher children BMI, 0.05 (0.02–0.08) higher BMI-z, 0.41% (0.22%–0.59%) higher waist circumference, and 0.24% (0.03%–0.46%) higher SBP. Each 1 kg/week higher GWG rate in mid- and late-pregnancy was associated with higher children SBP (4.58% [1.46%–7.71%]), triglycerides (18.28% [3.13%–33.44%]), and fasting glucose (5.83% [2.64%–9.02%]) and lower BMI-z (−0.45 [−0.82 to −0.08]). Additional adjustment for offspring BMI attenuated the associations for maternal BMI but not for GWG rate. ConclusionsThe increase in maternal BMI and GWG are associated with adverse cardiometabolic profiles in childhood. The association between maternal BMI and childhood cardiometabolic traits is likely mediated using the offspring BMI.

Operation of downhole pumps under sanding conditions

One of the unfavourable factors of downhole pumping equipment operation at the fields at the final stage of development is high content of mechanical impurities in the pumped fluid. Similar problems are observed in fields with friable, weakly cemented formations, the fracture products of which flow downhole, resulting in lower extraction rates, equipment damage and higher operating costs. In oil production practice various technological measures and technical means are used to reduce the negative impact of sand penetration - regulation and optimisation of pumping equipment operation mode to ensure a rational rate of fluid withdrawal, application of technical devices in the form of sand filters and sand anchors and others. However, these measures and recommendations, for the most part, work successfully in the modes of continuous operation of wells. With the growing number of oil fields at the final stage of development, the issue of sanding becomes more and more urgent, as due to low flow rate wells at such fields are often switched to the mode of periodic operation, which favours the formation of sand plugs in tubing above the pump due to sufficient time for sedimentation of mechanical impurities. This can lead to pump jamming or rod breakage during subsequent well pump start-up. The experience of using sand filters (frame, slotted and others) in the arrangement of downhole pumps has shown that it does not always effectively solve the problem of sand penetration due to clogging of their cells with mechanical impurities and increased hydraulic resistance. This negatively affects the pumping equipment operation due to the shift of characteristics into the zone of suboptimal modes with associated problems for the electric drive. This makes it necessary to carry out underground well workover with removal of deep well pumping equipment for replacement or washing of the filter in surface conditions, as due to their peculiarities in the well pump layout (the filter is located at the intake of the pumping section), washing in well conditions is not always possible. These problems require not only the creation of effective downhole devices to prevent sand ingress to the pump intake or devices to prevent sand plugs above it, but also acceptable in practice calculation methods for predicting the sedimentation time of mechanical impurities in tubing or determining the minimum required speed of upward oil flow for stable sand removal. These calculation methods would also allow to reasonably regulate the time of technological interruptions while waiting for the wells to start up in periodic operation modes or to predict the time of activation of sand control devices for discharging the sand accumulated above the pump. This is the subject of this article. As a result of calculation analysis it was established that the main factors affecting the sedimentation process of mechanical impurities in the well are the speed and mode of fluid movement, its viscosity, density and size of the impurities themselves. Moreover, the most sensitive for the calculation accuracy is to take into account the change of fluid viscosity as it moves along the tubing as a result of heat exchange and the change of dissolved gas content due to pressure drop. Although at this stage the proposed methodology does not take into account some factors that can make additional adjustments to the process of sand sedimentation, however, it allows to predict with acceptable accuracy the time of technological interruptions in the well operation to prevent the formation of sand plugs, or the rational mode of operation of pumping equipment, providing the necessary speed of upward flow in the pipe for sand removal.

Design and implementation of an encoder calibration system for improved resolution and accuracy in IPMSM drive with embedded software

ABSTRACT This paper presents an encoder calibration system to enhance resolution and accuracy in an interior permanent magnet synchronous motor (IPMSM) drive, along with custom embedded software. The system implements closed-loop control with the IPMSM drive, adjusting the encoder resolution through gear ratio adjustments. Communication between the human-machine interface (HMI) and the DSP’s internal 28× CPU is achieved via digital communication RS-422 interface. The embedded software on the 28× CPU processes real-time data and displays calibration information on the HMI. Firmware integration includes external analog/digital converters, comparators, digital communication interfaces, high-accuracy encoders, original encoders, and additional gear ratio adjustments, with computed compensation values stored in EEPROM. The TMS-320F-28335 digital signal processor serves as the control core, enabling encoder signal processing, embedded software execution, HMI operation, and IPMSM drive control. The experimental results validate the practicality of the proposed digitization method, demonstrating its effective applicability in industrial control systems.

Association of maternal ultra-processed food consumption during pregnancy with atopic dermatitis in infancy: Korean Mothers and Children’s Environmental Health (MOCEH) study

BackgroundMaternal diet during pregnancy might influence the development of childhood allergic disorders. There are few studies on the association between processed food intake and infant atopic dermatitis (AD) during pregnancy. The aim of the present study was to investigate the association of ultra-processed food (UPF) intake during pregnancy with infantile AD.MethodsThis study involved 861 pairs of pregnant women and their offspring from the Mothers’ and Children’s Environmental Health (MOCEH) study, a multi-center birth cohort project conducted in Korea. Dietary intake was estimated using a 24-h recall method at 12−28 weeks gestation. The NOVA classification was used to identify UPF, and UPF intake was calculated as the percentage of total energy consumption and categorized into quartiles. Infantile AD was assessed based on medical history and the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC). Associations were assessed by logistic regression with adjustment for confounding factors.ResultsChildren born to mothers in the highest quartile of UPF consumption (15.5% or more of the total energy) compared to the lowest quartile (6.8% or less) showed a higher risk of AD within 12 months [odds ratio (OR) = 1.69; 95% confidence interval (CI): 1.07−2.66, P for trend 0.0436]. After adjustment for the confounding factors under study, the association was strengthened; the adjusted OR between extreme quartiles was 2.19 (95% CI: 1.11–4.32, P for trend = 0.0418). This association was maintained even after an additional adjustment based on the Korean Healthy Eating Index (KHEI), an indicator of diet quality.ConclusionsHigher maternal consumption of UPF during pregnancy was associated with a greater risk of infantile AD within the first year of life.

Association of Age at Menarche with Inflammation and Glucose Metabolism Biomarkers in U.S. Adult Women: NHANES 1999-2018.

Early age at menarche (AAM) is a risk factor for type 2 diabetes later in life, but the pathogenic pathways that confer increased risk remain unknown. We examined the associations between AAM and inflammatory and glucose metabolism biomarkers among U.S. adult women who were free of diabetes. Using the National Health and Nutrition Examination Survey (NHANES) 1999-2018, 19,228 women over 20 years old who were free of self-reported cancer and diabetes were included in this cross-sectional analysis. AAM was the self-reported age at first menstruation. CRP, fasting glucose, fasting insulin, and ferritin levels were measured as biomarkers of inflammation and glucose metabolism in adult blood samples using latex-enhanced nephelometry, enzymatic, and immunoassay methods. Multiple linear regression was used to relate AAM to the biomarkers. The median age at the time of blood sample collection was 44 years (IQR, 33-62). After age adjustment, there was an association between a lower AAM and higher CRP (P-trend=0.006); fasting glucose (P-trend<0.0001); fasting insulin (P-trend <0.0001); and ferritin (p-trend<0.0001). These remained significant after additional adjustment for demographic, reproductive, lifestyle, and adiposity variables, except for ferritin. Smoking modified the effect of AAM on CRP (p-interaction = 0.014), fasting insulin (p-interaction <0.001), and fasting glucose (p-interaction<0.001). In stratified analysis, the observed associations became more pronounced in non-smokers, while they were attenuated to non-significance in active smokers. Earlier age at menarche is associated with an unfavorable inflammatory and glucose metabolic biomarker profile in a nationally representative sample of adult women free of diabetes, especially among non-smokers.

Association between masticatory function, frailty, and functional disability: an observational study

BackgroundIncrease in functional disability in aging societies is an international medical and public health issue. Masticatory function may be a potential risk factor for functional disability, but the role of frailty in the association has not been clarified.MethodsForty thousand five hundred sixty-two community-dwelling older adults aged 65 years and over who were insured by public health insurance as of April 2018 were followed up for a median of 3.0 years. Masticatory function was categorized as good, moderate, or poor based on a self-reported questionnaire. The development of functional disability was defined as a new certification of the need for long-term care. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs).ResultsDuring the follow-up period, 1,397 individuals experienced functional disability. After adjusting for age, sex, comorbidities, medical history, and lifestyle behaviors, the HR for incident functional disability was significantly higher in the moderate and poor groups compared to the good group (moderate, HR 1.21 [95% CI, 1.07–1.37]; poor, HR 1.64 [95% CI, 1.03–2.62]). However, after additional adjustment for frailty-related factors—namely, underweight, regular exercise, and gait speed—the association was attenuated in both the moderate group (HR 1.06 [95% CI, 0.94–1.21]) and the poor group (HR 1.51 [95% CI, 0.94–2.41]).ConclusionsMasticatory dysfunction was significantly associated with incident functional disability in a community-dwelling older Japanese population. Our findings suggest that masticatory dysfunction may be a surrogate of frailty rather than a direct cause of functional disability.

Elucidating the Link Between Anxiety/Depression and Alzheimer’s Dementia in the Australian Imaging Biomarkers and Lifestyle (AIBL) Study

BackgroundThe associations between mood disorders (anxiety and depression) and mild cognitive impairment (MCI) or Alzheimer’s dementia (AD) remain unclear.MethodsData from the Australian Imaging, Biomarker & Lifestyle (AIBL) study were subjected to logistic regression to determine both cross-sectional and longitudinal associations between anxiety/depression and MCI/AD. Effect modification by selected covariates was analysed using the likelihood ratio test.ResultsCross-sectional analysis was performed to explore the association between anxiety/depression and MCI/AD among 2,209 participants with a mean [SD] age of 72.3 [7.4] years, of whom 55.4% were female. After adjusting for confounding variables, we found a significant increase in the odds of AD among participants with two mood disorders (anxiety: OR 1.65 [95% CI 1.04–2.60]; depression: OR 1.73 [1.12–2.69]). Longitudinal analysis was conducted to explore the target associations among 1,379 participants with a mean age of 71.2 [6.6] years, of whom 56.3% were female. During a mean follow-up of 5.0 [4.2] years, 163 participants who developed MCI/AD (refer to as PRO) were identified. Only anxiety was associated with higher odds of PRO after adjusting for covariates (OR 1.56 [1.03–2.39]). However, after additional adjustment for depression, the association became insignificant. Additionally, age, sex, and marital status were identified as effect modifiers for the target associations.ConclusionOur study provides supportive evidence that anxiety and depression impact on the evolution of MCI/AD, which provides valuable epidemiological insights that can inform clinical practice, guiding clinicians in offering targeted dementia prevention and surveillance programs to the at-risk populations.

DNA Methylation at C-Reactive Protein-Associated CpG Sites May Mediate the Pathway Between Educational Attainment and Cognition.

Growing evidence has linked inflammatory processes to cognitive decline and dementia. This work examines whether an epigenetic marker of C-reactive protein (CRP), a common clinical inflammatory biomarker, may mediate the relationship between educational attainment and cognition. We first evaluated whether 53 previously reported CRP-associated DNA methylation sites (CpGs) are associated with CRP, both individually and aggregated into a methylation risk score (MRSCRP), in 3298 participants from the Health and Retirement Study (HRS, mean age = 69.7 years). Forty-nine CpGs (92%) were associated with the natural logarithm of CRP in HRS after adjusting for age, sex, smoking, BMI, genetic ancestry, and white blood cell counts (p < .05), and each standard deviation increase in MRSCRP was associated with a 0.38 unit increase in lnCRP (p = 4.02E-99). In cross-sectional analysis, for each standard deviation increase in MRSCRP, total memory score and total cognitive score decreased, on average, by 0.28 words and 0.43 items, respectively (p < .001). Further, MRSCRP mediated 6.9% of the relationship between high school education and total memory score in a model adjusting for age, sex, and genetic ancestry (p < .05); this was attenuated to 2.4% with additional adjustment for marital status, APOE ε4 status, health behaviors, and comorbidities (p < .05). Thus, CRP-associated methylation may partially mediate the relationship between education and cognition at older ages. Further research is warranted to determine whether DNA methylation at these sites may improve current prediction models for cognitive impairment in older adults.

Association between Neighborhood Stressors and Allostatic Load in Breast Cancer Survivors: The Pathways Study.

Allostatic load (AL) is an intermediary outcome through which neighborhood drivers of health may impact cancer survivorship outcomes. We examined associations of neighborhood stressors and AL in 2,553 women with breast cancer recruited into the Pathways Study in 2006-2013. AL score was derived from biomarkers in the cardiovascular, metabolic, and immune domains of physiological stress measured within 3 years after baseline. Neighborhood data were appended to participants' geocoded baseline addresses. Odds ratios (OR) and 95% confidence intervals (CI) were used to estimate associations between neighborhood stressors and risk of higher AL score. Adjusting for age and stage, high AL was positively associated with low versus high neighborhood socioeconomic status (nSES; OR=2.24, 95% CI=1.61-3.12) and green space (OR=1.55, 95% CI=1.18-2.03); high versus low traffic (OR=1.32, 95% CI=1.01-1.72), crime (OR=1.32, 95% CI=1.05-1.67), and household crowding (OR=1.57, 95% CI=1.22-2.01); and more versus no fast-food restaurants (OR=1.50, 95% CI=1.21-1.84). Associations remained for nSES and fast-food restaurants after co-adjustment with other neighborhood stressors, and for fast-food restaurants after additional adjustment with individual sociodemographic and lifestyle factors. Our preliminary findings can inform further studies of the physiological effects of neighborhood stressors, which collectively may help improve survivorship outcomes for the growing population of breast cancer survivors.

Associations between body composition and intradialytic hypotension (IDH), and between IDH and prognosis, in hemodialysis patients

BackgroundPrevious studies describing relationships among body compositions, intradialytic hypotension (IDH), and mortality yielded inconsistent results. We studied associations between body composition and IDH, and between IDH and prognosis, in patients on hemodialysis (HD).MethodsParticipants were patients on maintenance HD and predilution online hemodiafiltration (HDF) (n = 303). IDH was defined as nadir systolic blood pressure (SBP) < 90 mmHg for ≥ 2 of 10 dialysis sessions during the exposure period (days 1–22). Clinical data at day 1 and post-dialysis body compositions using bioelectrical impedance analysis conducted once during the exposure period were collected. Differences between the IDH and non-IDH groups were analyzed. Kaplan–Meier survival curves of the IDH and non-IDH groups, logistic regression analyses of IDH, and Cox proportional hazard analyses of all-cause and cardiovascular (CV) mortality in all participants were also performed.ResultsIn all participants, the median (median [interquartile range]) age was 67 [56–74] years, median dialysis duration was 76 [37–145] months, and diabetes prevalence was 42.6% (129/303). Compared with the non-IDH group (n = 274), the IDH group (n = 29) had a lower mean pre-dialysis SBP during the exposure period, longer dialysis duration, lower serum albumin levels, and higher median fat tissue index (10.7 [8.6–14.9] versus 9.5 [6.8–11.9] kg/m2, P < 0.05). The IDH group had lower 3-year survival for all-cause and CV mortality (P < 0.05). When adjusted for mean pre-dialysis SBP, mean ultrafiltration volume during the exposure period, HDF, dialysis duration, and serum albumin, fat tissue index, and lean tissue index were associated with IDH (P < 0.05), but body mass index and overhydration/extracellular water were not. After additional adjustments for age, sex, and diabetes mellitus, only fat tissue index was a significant predictor for IDH [odds ratio: 1.12 (95% confidence interval 1.02–1.25), P < 0.05]. IDH was also a significant predictor of 3-year all-cause and CV mortality (P < 0.05).ConclusionsIncreased fat tissue index was a significant risk factor for IDH in HD and HDF patients. Furthermore, IDH was a significant predictor of 3-year all-cause and CV mortality in HD and HDF patients.

Digoxin and Risk of Ventricular Tachyarrhythmia and Death in ICD Recipients

BackgroundSome studies have shown digoxin use to be associated with adverse outcomes, including increased mortality. There are limited data on whether digoxin use is associated with increased risk of ventricular tachycardia/ventricular fibrillation (VT/VF) in heart failure patients with an implantable cardioverter-defibrillator (ICD). ObjectivesThis study sought to assess whether digoxin use is associated with increased risk of VT/VF in patients with heart failure with reduced ejection fraction with a primary prevention ICD in landmark clinical trials. MethodsThe study cohort consisted of patients with an ICD or cardiac resynchronization therapy-defibrillator who were enrolled in 4 landmark MADIT trials (Multicenter Automatic Defibrillator Implantation Trials). We employed propensity score quintile stratification for treatment with digoxin as well as additional multivariable adjustment to assess the risk of digoxin vs no-digoxin therapy for the endpoints of first and recurrent VT/VF and all-cause mortality. The proportional hazards regression models for arrhythmia-specific endpoints incorporated adjustments for the competing risk of death. ResultsAt baseline, 1,155 of 4,499 patients were on digoxin (26%). After propensity score quintile stratification, patients prescribed digoxin were shown to exhibit a statistically significant 48% increased risk of VT/VF (P < 0.001), 42% increased risk of the composite of VT/VF or death (P < 0.001), and a 37% increased risk of all-cause mortality (P = 0.006). Digoxin use was also associated with increased risk of appropriate ICD shocks (HR: 1.91; P < 0.001) and with increased burden of VT/VF events (HR: 1.46; P = 0.001). ConclusionsOur findings suggests that digoxin use is associated with ventricular tachyarrhythmia and death in heart failure with reduced ejection fraction patients with an ICD.