Greater Age Research Articles

A Novel and Comprehensive Wellness Assessment for Lifestyle-Based Interventions.

While weight status and clinical laboratory measures are important in assessing obesity-related disease severity and chronic disease risk, including a broader range of emotional, psychosocial, and behavioral factors would provide greater context of an individual's overall state of wellness and could be used to better guide treatment decisions. The purpose of this research was to develop a comprehensive Lifestyle Wellness assessment for use in lifestyle-based wellness interventions and programs. A cross-sectional exploratory factor analysis (EFA) was conducted using baseline data from N=138 adults participating in behavioral weight loss trials. An unweighted least squares extraction method with oblique rotation was used. Twenty-one putative measures spanning constructs related to metabolic health, emotional health/wellbeing, body weight and composition, diet quality, and fitness were analyzed for retention. Mean body mass index (BMI) was 38.0±6.6kg/m2, mean age was 57.3±11.1years, and 77.5% of participants were female. The EFA produced a five-factor model with 13 items that explained 80.3% of the variance. The retained factors included: (1) Psychosocial State: mindfulness, resilience, quality of life, and happiness; (2) Blood Pressure State: systolic and diastolic blood pressure; (3) Lipid State: total cholesterol and LDL-cholesterol; (4) Fitness State: grip strength, jump height, and percent body fat; and (5) Body State: BMI and waist circumference. Lifestyle Wellness is a comprehensive assessment that enables innovative wellness-related research such as metabolically healthy obese phenotypes and weight-neutral interventions. Future research should include investigations in additional populations with greater age, sex/gender, and body size diversity.

Integrated hip surveillance pathways for pain, function and quality of life in children with Cerebral Palsy: A systematic literature review.

To determine the effectiveness of integrated hip surveillance pathways on pain, function and quality of life (QOL) in children with Cerebral Palsy (CP). A systematic literature review, designed, conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. confirmed CP diagnosis, management under recognised international hip surveillance pathways, outcome measures of hip displacement plus at least one other relevant to pain, function or QOL. 100 articles were identified. 12 full text articles were screened, and four were included. Reduced range of movement was associated with hip pain in children with CP. Increasing age, Gross Motor Function Classification Score (GMFCS) and migration percentage (MP) were associated with increased hip pain. General health declined with increased age. Increased MP and GMFCS level were associated with interruption to activities of daily living. Outcomes relating to function and QOL are under-researched in the current integrated hip surveillance pathway evidence-base. Wider outcomes related to function and QOL need to be included to capture the wider impact on children who are at risk of hip dislocation. Increased pain was associated with reduced joint range and increased migration percentage. Pain also increased with greater age and Gross Motor Function Classification Score. Early orthopaedic intervention for hip displacement may not successfully mitigate pain. Effectiveness of integrated pathways on function and quality of life is under-evidenced. Studies investigating integrated pathways and holistic outcomes are needed to inform practice.

In utero and childhood exposure to the great Chinese famine and risk of aging in adulthood

Background Early-life exposure to famine may influence the occurrence of chronic diseases and aging in midlife among those exposed. This study aims to explore the relationship between exposure to the Chinese Great Famine and aging in middle-aged individuals. Methods Participants born in 1963–1965 (unexposed), 1959–1961 (in utero exposure), and 1955–1957 (childhood exposure) from the Kailuan Study were included. Their biological age at 2010, 2014, and 2018 was investigated, and age acceleration (biological age minus actual age) was calculated to assess aging. Logistic regression analysis was employed to describe the relationship between famine exposure and the aging risk. Subgroup and sensitivity analysis were conducted to explore differences and stability in this relationship among different groups. Results A total of 17,543 participants were included in this study. Among them, 12,762 (72.7%) were male, and 4,781 (27.3%) were female, with 2,543 participants experiencing aging events. Compared to unexposed participants, those exposed during childhood and in utero exhibited a 1.69-fold (OR = 1.69, 95%CI: 1.53–1.87) and 1.22-fold (OR = 1.22, 95%CI: 1.08–1.37) increased risk of aging. Subgroup analysis revealed an interaction with income (P for interaction = 0.008), and additional interaction analysis suggested that increasing income could partially mitigate the detrimental effects of early-life famine exposure. Furthermore, experiencing famine in severely affected regions exacerbated the risk of aging (OR = 1.41, 95%CI: 1.21–1.63). Conclusion Exposure to famine in utero or during childhood may elevate the risk of midlife aging among exposed individuals, and these relationships are influenced by the severity of famine exposure. Increasing income may also help mitigate these effects.Trial registration: Kailuan study, ChiCTRTNRC11001489. Registered July 19, 2015 Retrospectively registered, https//www.chictr.org.cn/showprojEN.html?proj=8050&u_atoken=af46a0dee8d73f320bb5459ab7bbcfa9&u_asig=1a0c381017255295896468605e00cf .

Characterization of the Biological Variability of the Angiome Biomarkers over Time in Healthy Subjects.

Biomarker analyses are an integral part of cancer research. Despite the intense efforts to identify and characterize biomarkers in cancer patients, little is known regarding the natural variation of biomarkers in healthy populations. Here we conducted a clinical study to evaluate the natural variability of biomarkers over time in healthy participants. The angiome multiplex array, a panel of 25 circulating protein biomarkers, was assessed in 28 healthy participants across 8 timepoints over the span of 60 days. We utilized the intraclass correlation coefficient (ICC) to quantify the reliability of the biomarkers. Adjusted ICC values were calculated under the framework of a linear mixed-effects model, taking into consideration age, sex, body mass index (BMI), fasting status, and sampling factors. ICC was calculated to determine the reliability of each biomarker. HGF was the most stable marker (ICC=0.973), while PDGF-BB was the most variable marker (ICC=0.167). In total, ICC analyses revealed that 22 out of 25 measured biomarkers display good (≥0.4) to excellent (>0.75) ICC values. Three markers (PDGF-BB, TGF-1, PDGF-AA) had ICC values <0.4. Greater age was associated with higher IL-6 (p=0.0114). Higher BMI was associated with higher levels of IL-6 (p=0.0003) and VEGF-R3 (p=0.0045). Of the 25 protein biomarkers measured over this short time period, 22 markers were found to have good or excellent ICC values, providing additional validation for this biomarker assay. This data further supports the validation of the angiome biomarker assay and its application as an integrated biomarker in clinical trial testing.

Correlation of Serum Lactate and Shock Index as Mortality Predictor in Polytrauma Patients

In polytrauma patients, serum lactate and hypovolemic shock are critical biomarkers for prognosis and treatment guidance. Elevated lactate levels indicate tissue hypoperfusion and anaerobic metabolism, often correlating with increased mortality. Objective: To analyze the correlation between serum lactate levels and shock index as predictors of in-hospital mortality in polytrauma patients. Methods: A Cohort study was conducted from August 2022 to July 2023 at a single tertiary care hospital in Karachi. Patients were chosen via consecutive sampling techniques and included adult patients with polytrauma injuries (ISS ≥ 15) who survived at least 24 hours. Patients with a history of diabetes were excluded. The serum lactate levels and shock index at the time of admission and over the first 24 hours were the exposures while in-hospital mortality, was the primary outcome. Statistical analyses were conducted using Stata 16.0. Categorical variables were analyzed using the chi-square test. Multivariable logistic regression evaluated mortality risk, adjusting for age, ISS, and shock index. Results: The in-hospital mortality rate in the study was 6.4% with significant predictors of mortality included increasing age (47.05 vs. 27.62 years, p&lt;0.001), higher Injury Severity Scores (ISS) (24 vs. 19, p= 0.02), and elevated shock index at admission (0.84 vs. 0.71, p&lt;0.001). Lactate metrics were strongly associated with mortality, showing significant correlations. Conclusions: Higher serum lactate levels and shock index are strong predictors of mortality in polytrauma patients. Greater age and injury severity also contribute to poorer outcomes.

Longitudinal assessment of systolic anterior motion of the mitral valve in cats with hypertrophic cardiomyopathy.

The proportion of cats with hypertrophic cardiomyopathy (HCM) that lose systolic anterior motion of the mitral valve (SAM) in the long term is unknown. Cats with HCM will lose SAM in the long term. Loss of SAM will be associated with greater age, longer scan-interval, and alteredleft ventricular (LV) dimensions. Sixty unsedated cats with HCM, not receiving beta blockers or pimobendan. A retrospective cohort study from 2 referral centers. Cats were eligible if they had been diagnosed with HCM and had a repeat echocardiogram ≥1 year later. Clinical and echocardiographic data of the left heart variables were collected. Thirty-eight cats had SAM at the initial scan. After a median follow-up time of 2.1 years (range: 1.0-5.9), 7 cats had lost SAM (18%) and 5 cats (23%) gained SAM. On follow-up, cats with SAM at the initial scan had a larger left atrium (P = .037), lower left atrial fractional shortening (P = .014), greater LV internal diameter in end-systole (P = .002), and lower LV fractional shortening (P < .001). Four cats with SAM developed congestive heart failure. There were no new cases of congestive heart failure or change in left heart variables in cats without SAM at the initial scan. The gain or loss of SAM was not associated with age or time between scans. Similar proportions of cats gained or lost SAM. Cats with SAM at baseline had more evidence of disease progression than cats without SAM.

Interactions between muscle volume and body mass index on brain structure in the UK Biobank.

Low skeletal muscle volume may increase dementia risk through mechanisms affecting brain structure. However, it is unclear whether this relationship exists outside of sarcopenia and/or varies by other factors. We aimed to study the interplay between skeletal muscle volume and factors, such as age, sex, and body mass index (BMI), in explaining brain structure at midlife in a cohort without sarcopenia. We used abdominal and brain magnetic resonance imaging (MRI) data from a population-based cohort enrolled in the UK Biobank. The following measures were derived: thigh fat-free muscle volume (FFMV), total brain volume (TBV), gray matter volume (GMV), white matter volume (WMV), total hippocampal volume (THV), and white matter hyperintensity volume (WMHV). Participants below sex-based grip strength thresholds suggesting probable sarcopenia were excluded. Linear regression analysis was used to study the interaction or mediation effects of age, sex, and BMI on the associations between FFMV and brain volumes. Data were available for 20,353 participants (median age 64 years, 53% female). We found interactions between thigh FFMV, BMI, and age (all p < 0.05). Greater thigh FFMV was associated with better brain volumes in those aged <64 years with normal (TBV: β = 2.0 ml/L, p = 0.004; GMV: β = 0.8 ml/L, p = 0.04; WMV: β = 1.1 ml/L, p = 0.006; WMHV: β = -0.2 ml/L, p = 3.7 × 10-5) or low BMI (TBV: β = 21.2 ml/L, p = 0.003; WMV: β = 13.3 ml/L, p = 0.002, WMHV: β = -1.1 ml/L, p = 0.04). Greater thigh muscle volume correlates with better brain volumes at midlife in people without sarcopenia, but this relationship weakens with greater age and BMI. Further study is required to investigate the underlying mechanisms to understand which components of body composition are potentially modifiable risk factors for dementia.

Work-Related Strain, Sense of Coherence and Intercultural Sensitivity Among Mental Health Nurses in Qatar: ACross-Sectional Study.

Migrant nurses face many challenges as they adapt and assimilate into their new working environments. The aim of this cross-sectional study was to investigate the perceptions of work-related strain, sense of coherenceand intercultural sensitivity among nurses who were employed at a public mental health facility in Qatar. We used three self-report questionnaires: the work-related strain inventory, sense of coherence scale and an intercultural sensitivity scale. A cohort of 136 nurses voluntarily engaged in the study. The majority of participants were male, migrated from South Asia and were in their mid-30s. The study found that both sense of coherence and intercultural sensitivity were inversely proportional to work-related strain. Work-related strain was found to be lower than expected; the factors that appear to protect against work-related strain include longer clinical experience, a high sense of coherence, and intercultural sensitivity. Additionally, greater age and extended clinical experience, combined with a history of work in three or more countries, associated with higher scores on the sense of coherence scale. Lastly, being female, having a postgraduate degree and holding a senior-level position were associated with increased intercultural sensitivity. As nurses' migration across national and international borders increases in response to global demand, this study has important implications for nursing administrators, educators and policymakers in relation to the development and implementation of strategies to enhance nurses' sense of coherence and intercultural sensitivity and prevent work-related strain. Trial Registration number: NCT04196751.

Lumbar foraminal stenosis was associated with back pain and leg pain: epidemiological evidence from a population-based cohort.

To determine the characteristics of lumbar foraminal stenosis (LFS) on magnetic resonance (MR) images and their association with back pain and radiating leg pain in a population-based sample of Chinese subjects. This study was an extension of the Hangzhou Lumbar Spine Study, a cross-sectional study focusing on back pain and lumbar spine MR imaging findings. Questionnaire data, including demographics, lifestyle, occupational exposures, back pain and radiating leg pain were included. On lumbar spine MR images, disc degeneration was assessed using Pfirrmann grade and Modic changes were evaluated. Using Lee's scale, the L3-S1 intervertebral foramina were evaluated, with grade 2-3 representing substantial LFS and grade 0-1 no LFS. Characteristics of LFS were noted, and associations of LFS with back pain and radiating leg pain were examined. Among the 644 study subjects, 141 (21.9%) had at least one LFS, and its occurrence was associated with greater age (OR = 1.93 for each 10 years, p < 0.001). Substantial LFS was associated with the presence of back pain (OR = 1.92, p = 0.001) and the intensity of the worst back pain (Coef = 8.30, p < 0.001) over the past 12 months, and disabling back pain during their lifetime (OR = 2.25, p < 0.001). Substantial LFS was also associated with leg pain (OR = 14.27, p < 0.001), with a sensitivity of 75.7% for the presence of radiating leg pain and a specificity of 81.4%. Substantial LFS on MR images was a common age-related degenerative phenotype in adults, and appears to be an independent risk factor for back pain and leg pain.

Gene expressivity on educational attainment increases with age, and then slows

The relative contributions of genetic and environmental influences to phenotypes vary with age. A Wilson effect denotes age-related increases in heritability, and an anti-Wilson effect the opposite (specifically a decline in heritability in late life). To date, few molecular-genetic studies of these effects have been conducted. Here we tested for Wilson effects on educational attainment (EA), leveraging a dataset with a wide age range (18–60 years) and polygenic scores (PGSs) for EA. Using a two-way interaction model, we estimated changes in the predictive power of one such PGS (specifically EA3) for EA as a function of aging. We found that the PGS predicted EA better in older participants (semi-partial regression coefficient [sr] = 0.05, 95%CI = 0.00, 0.10), potentially consistent with a Wilson effect. The effect of EA32 had a further independent negative effect on EA in older participants (sr = −0.06, 95%CI = −0.11, −0.01), indicating that the Wilson effect slows with greater age. The findings suggest that PGS expressivity increases as individuals attain an educationlevel in line with their abilities and preferences as they age. But past a relatively early age (in almost all cases), the maximal level of education in line with genetic liability is reached, and PGS expressivity plateaus. Beyond this point PGS expressivity may even start to decline (an anti-Wilson effect), which, rather than reflecting the developmental dynamics of EA itself, could result from the known tendency for episodic and semantic memory to decline later in life, leading to misrecollection of certain life events (which could cause erroneous recall of level of EA). Caution is warranted in interpreting these results, however, since, owing to the cross-sectional nature of our study, there are potential confounding factors at play.

Hypertension among persons with type 2 diabetes and its related demographic, socioeconomic and lifestyle factors in the Fasa cohort study

Hypertension is a very common comorbidity in type 2 diabetes patients, which leads to important health and treatment challenges. The present study was conducted with the aim of determining the prevalence of hypertension and its risk factors in type 2 diabetes patients. This study was conducted using cross-sectional data from 1245 participants aged between 35 and 70 years and diagnosed with type 2 diabetes at baseline in the Fasa cohort study. The prevalence hypertension was determined and multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between various risk factors and hypertension prevalence. The average age of the participants was 53.5 ± 8.7 years and 71.7% (n = 893) were female and 28.3% (n = 352) were male. The prevalence of hypertension in people with type 2 diabetes was 45.5% (n = 566). Higher age (AOR, 95% CI: 8.1, 4.6–14.3), female gender (OR, 95% CI: 1.8, 1.2–2.5), Fars (AOR, 95% CI: 1.6, 1.1–2.4) and Turk (AOR, 95% CI: 1.6, 1.1–2.5) vs. other ethnicity, and overweight (AOR, 95% CI: 1.8, 1.38–2.38) and obesity (AOR, 95% CI: 2.7, 2.0–3.8) vs. BMI < 25 was associated with a higher prevalence of hypertension, while higher physical activity (AOR, 95% CI: 0.57, 0.42–0.78) was associated with lower prevalence of hypertension in the multivariable model. The prevalence of hypertension in persons with type 2 diabetes was high and increased with greater age, in some ethnic groups, and with higher BMI and low physical activity. Further prospective studies are needed to investigate these associations in this population.

Reproductive factors and risk of cardiovascular outcomes in women with ST-elevation myocardial infarction

BackgroundThere are many sex-specific factors affecting myocardial infarction (MI) outcomes in males and females. This study aimed to evaluate the relationship between reproductive factors and cardiovascular outcomes in women after ST-elevation MI.MethodThis retrospective cohort study was initiated in 2016–2017 at Chamran Hospital, Isfahan, Iran. One hundred eighty women with a diagnosis of ST-elevation MI were followed up for 3 years, and any occurrence of cardiovascular events (CVs) was recorded. All information regarding reproductive factors was recorded via questionnaire. This information was compared between women with cardiovascular events and women without adverse events using a sample t test, chi-square test, and multiple backward logistic regression analysis. SPSS version 24 was used to conduct all analyses.ResultSixty-four women with a mean age of 65.81 ± 13.14 years experienced CV events, and 116 women with a mean age of 65.51 ± 10.88 years did not experience CV events. A history of ischemic heart disease and diabetes mellitus were more prevalent in women with CV events (P = 0.024 and P = 0.019). After adjusting for ischemic heart disease and diabetes mellitus, oral contraceptive pill (OCP) usage was more prevalent in women with CV events than in women without CV events (60.9% vs. 40.4%, P = 0.008). There was a greater chance of CV events in women with OCP usage (OR = 3.546, P = 0.038) and a lower chance of CV events in women with greater age at menarche (OR = 0.630, P = 0.009) and longer breastfeeding duration (OR = 0.798, P = 0.041) according to multiple backward logistic regression models.ConclusionBased on this study, OCP consumption is a risk factor, while older age at menarche and longer duration of breastfeeding are protective factors for cardiovascular outcomes in women after STEMI.

The taxonomic composition and chronology of a museum collection of Coleoptera revealed through large-scale digitisation

IntroductionHistoric museum collections hold a wealth of biodiversity data that are essential to our understanding of the rapidly changing natural world. Novel curatorial practices are needed to extract and digitise these data, especially for the innumerable pinned insects whose collecting information is held on small labels.MethodsWe piloted semi-automated specimen imaging and digitisation of specimen labels for a collection of ~29,000 pinned insects of ground beetles (Carabidae: Lebiinae) held at the Natural History Museum, London. Raw transcription data were curated against literature sources and non-digital collection records. The primary data were subjected to statistical analyses to infer trends in collection activities and descriptive taxonomy over the past two centuries.ResultsThis work produced research-ready digitised records for 2,546 species (40% of known species of Lebiinae). Label information was available on geography in 91% of identified specimens, and the time of collection in 39.8% of specimens and could be approximated for nearly all specimens. Label data revealed the great age of this collection (average age 91.4 years) and the peak period of specimen acquisition between 1880 and 1930, with little differences among continents. Specimen acquisition declined greatly after about 1950. Early detected species generally were present in numerous specimens but were missing records from recent decades, while more recently acquired species (after 1950) were represented mostly by singleton specimens only. The slowing collection growth was mirrored by the decreasing rate of species description, which was affected by huge time lags of several decades to formal description after the initial specimen acquisition.DiscussionHistoric label information provides a unique resource for assessing the state of biodiversity backwards to pre-industrial times. Many species held in historical collections especially from tropical super-diverse areas may not be discovered ever again, and if they do, their recognition requires access to digital resources and more complete levels of species description. A final challenge is to link the historical specimens to contemporary collections that are mostly conducted with mechanical trapping of specimens and DNA-based species recognition.

Association between delayed ambulation and increased risk of adverse events after lumbar fusion surgery in elderly patients

PurposeThe relationship between delayed ambulation (DA) and postoperative adverse events (AEs) following transforaminal lumbar interbody fusion (TLIF) in elderly patients remains elusive. The aim of our study was to evaluate the effects of DA on the postoperative AEs including complications, readmission and prolonged length of hospital stay (LOS).MethodsThis was a retrospective analysis of a prospectively established database of elderly patients (aged 65 years and older) who underwent TLIF surgery. The early ambulation (EA) group was defined as patients ambulated within 48 h after surgery, whereas the delayed ambulation (DA) group was patients ambulated at a minimum of 48 h postoperatively. The DA patients were 1:1 propensity-score matched to the EA patients based on age, gender and the number of fused segments. Univariate analysis was used to compare postoperative outcomes between the two groups, and multivariate logistic regression analysis was used to identify risk factors for adverse events and DA.ResultsAfter excluding 125 patients for various reasons, 1025 patients (≤ 48 h: N = 659 and > 48 h: N = 366) were included in the final analysis. After propensity score matching, there were 326 matched patients in each group. There were no significant differences in the baseline data and the surgery-related variables between the two groups (p > 0.05). The patients in the DA group had a significant higher incidence of postoperative AEs (46.0% vs. 34.0%, p = 0.002) and longer LOS (p = 0.001). Multivariate logistic regression identified that age, operative time, diabetes, and DA were independently associated with postoperative AEs, whereas greater age, higher international normalized ratio, and intraoperative estimated blood loss were identified as independent risk factors for DA.ConclusionsDelayed ambulation was an independent risk factor for postoperative AEs after TLIF in elderly patients. Older age, increased intraoperative blood loss and worse coagulation function were associated with delayed ambulation.

Area deprivation index and social vulnerability index in Milwaukee County: Impact on hospital outcomes after traumatic injuries

BackgroundPredisposing factors for traumatic injuries are complex and variable. Neighborhood environments may influence injury mechanism or outcomes. The Social Vulnerability Index (SVI) identifies areas at risk for emergencies; Area Deprivation Index (ADI) measures socioeconomic disadvantage. The objective was to assess the impact of SVI or ADI on hospital length of stay (LOS) and mortality for injured patients to determine whether SVI or ADI indicated areas where injury prevention may be most impactful. MethodsAdult patients who resided in Milwaukee County and were treated for injuries from 2015 to 2022 at a level I trauma center were included. Patients’ addresses were geocoded and merged with 2020 state-level SVI and ADI measures. SVI ranks census tracts 0–100 from least to most vulnerable. ADI ranks census block groups 1–10 from least to most disadvantaged. ADI and SVI rankings were converted to deciles. Statistical analyses included descriptive statistics, chi-square tests, and regression models for LOS and in-hospital mortality, adjusted for either SVI or ADI within separate models, age, sex, race or ethnicity, mechanism of injury (MOI), injury severity score (ISS). Results14,542 patients were included; 63 % were male. Mean total hospital LOS was 6.4 ± 9.8 days, and in-hospital mortalities occurred in 5.2 % of patients. Based on SVI and ADI, 5,280 (36 %) patients resided in high vulnerability areas and 5,576 (39 %) lived in highly disadvantaged areas, respectively. After adjusting for patient factors, SVI deciles #6, 9, 10 were associated with increased hospital LOS, and SVI decile #5 was associated with in-hospital mortality (OR = 2.22, 95 %CI:1.06–4.63; p = 0.034). When adjusted for ADI, the 7th-10th deciles were associated with increased hospital LOS. Greater age and ISS were associated with increased hospital LOS and mortality when adjusted for SVI and ADI. ConclusionsSVI and ADI identified a similar proportion of patients in high vulnerability or disadvantaged areas. Higher SVI and ADI deciles were associated with longer hospital LOS, and only the 5th SVI decile was associated with in-hospital mortality. Highly disadvantaged or vulnerable areas may have a longer LOS, but SVI and ADI have limited influence on trauma mortality. Continued research on neighborhood and community factors and trauma outcomes is needed.

Turbidite correlation for paleoseismology

Marine turbidite paleoseismology relies on the assumption of synchronous triggering of turbidity currents by earthquake shaking to infer rupture extent and recurrence. Such inference commonly depends on age dating and correlation of the physical stratigraphy of deposits carried by turbidity currents (i.e., turbidites) across great distances. Along the Cascadia subduction zone, which lies offshore the Pacific Northwest, USA, turbidite facies in core photographs, X-ray computed tomography images, and magnetic susceptibility (MS) data exhibit differences in character over relatively short distances, which implies that not all deposits can be correlated with confidence. Thus, subjective correlation based on expected similarity over great distances and weak age constraints does not independently support paleoseismic models. We present a new method for correlating turbidites along the Cascadia margin that can yield a more objective and repeatable stratigraphic framework to underpin earthquake recurrence. We use dynamic time warping to correlate MS logs and measure correlation coefficients of core pairs to evaluate correlation strength. We then compare these measures to a distribution of correlation coefficients of randomly generated turbidite sequences and find that only a small number of core pairs can be correlated more confidently than randomly stacked turbidites. This methodology promises a more robust correlation strategy for future stratigraphic studies.

Proximal junctional kyphosis after adult spinal deformity operated patients with long fusion to the pelvis. Does the type of proximal anchor matter?

To assess, in a large population of Adult Spinal Deformity (ASD) patients, the true interest of varying the upper anchors as a protective measure against Proximal Junctional Kyphosis (PJK), by analyzing and comparing 2 groups of patients defined according to their proximal construct. Another objective of the study is to look for any other factors, radiological or clinical, that would affect the occurrence of the proximal failure. Retrospective review of a prospective ASD database collected from 5 centers. Inclusion criteria were age of at least 18years, presence of a spinal deformity with instrumentation from T12 or above to the pelvis, with minimum 2years of follow-up. Demographic data, spinopelvic parameters, functional outcomes and complications were collected. Multiple logistic regression analysis was performed to identify the risk factors that would affect the occurrence of PJK. 254 patients were included. 166 in the group "screws proximally" (SP) and 88 in the group "hooks proximally" (HP). There was no difference between both groups for PJK (p = 0.967). The occurrence of PJK was rather associated with greater age and BMI, higher preoperative kyphosis, worst preoperative SRS22 and SF36 scores, greater postoperative Sagittal Vertical Axis (SVA), coronal malalignment and kyphosis. The use of proximal hooks was not effective to prevent PJK after ASD surgery, when compared to proximal screws. Worse preoperative functional outcomes and worse postoperative sagittal and also coronal malalignment were the main drivers for the occurrence of PJK regardless the type of proximal implant.

EMMA TENNANT’S tEss: HARDY’S CANONICAL NOVEL FROM A FEMALE REVISIONIST PERSPECTIVE

Depending on the perspective, Emma Tennant’s tess (1993) can be interpreted as a neo-Victorian, postmodernist, and revisionist novel. This paper is aimed at analyzing tess from the aspect of revisionism. By offering a familiar story from a female perspective and combining it with an imaginative biography of Hardy’s life and a polemic account of the history of women’s oppression, the narrator intends to challenge the well-known past and rewrite it. The Victorian era is represented as “the last great age of punishment for women”, but such representation is extended to Thomas Hardy. By presenting unknown facts that portray the writer in a negative context, the narrator intends to “shake” our understanding of the allegedly well-known past and break into history. The novel implies that the Victorian age was even bleaker than it is usually thought of, but this vision is extended to the present, which is arguably represented in an even grimmer light. By pointing to the patterns visible both in the past and the present, the narrator’s purpose is to highlight the timeless, universal topics that permeate all the literary and historical periods, such as the oppression of women. As suggested by the novel, the only way to end the tradition of women’s subordination and punishment is to allow women to tell their own stories.

Fertility among young breast cancer survivors attempting pregnancy: A prospective, multicentre cohort study.

1518 Background: Despite high interest among young women diagnosed with breast cancer (BC) in future fertility, prior research has been hampered by short follow-up and lack of prospective assessment of pregnancy attempts. We sought to describe fertility outcomes among young women participating in a prospective cohort who reported pregnancy attempt post-BC diagnosis. Methods: Women with stage 0-III BC in the Young Women's Breast Cancer Study (YWS, NCT01468246), a multicenter, prospective cohort of women diagnosed at age ≤40 from 2006-2016 who reported attempting pregnancy post-diagnosis were included. Those with prior hysterectomy, bilateral oophorectomy, or metastatic disease at diagnosis were excluded. Data on attempting pregnancy and fertility outcomes were obtained from serial surveys. Multivariable logistic regression with stepwise model selection was used to identify factors associated with pregnancy and live birth. Results: Among 1213 eligible participants, 197 reported any attempt of pregnancy (16%) over a median follow-up of 11 years (range: 3-17). Among attempters, median age at diagnosis was 32 years (range: 17-40); 74% were non-Hispanic White; 41% had stage I, 35% stage II, 10% stage III, and 14% stage 0 BC; 76% had HR+ disease; 68% received chemotherapy; 57% received endocrine therapy within one year post-diagnosis; 13% were BRCA1/2 pathogenic variant (PV) carriers; 51% reported financial comfort at baseline; 51% were nulligravida and 72% nulliparous at diagnosis; 28% had undergone fertility preservation consisting of egg/embryo freezing at diagnosis; 15% reported a history of infertility before BC diagnosis. Most (73%) reported ≥1 pregnancy after diagnosis and 65% reported ≥1 live birth. Median time from diagnosis to first pregnancy was 48 months (range: 6-125). In the multivariable model, greater age at diagnosis (odds ratio [OR] 0.82 per year increase, 95% CI 0.74-0.90, P&lt;0.0001) was negatively associated with pregnancy, while financial comfort at baseline (OR 2.04, 95% CI 1.01-4.12, P=0.047) was predictive of pregnancy. For live births, greater age at diagnosis was negatively associated (OR 0.82 per year increase, CI 95% 0.76-0.90, P&lt;0.0001) while having undergone fertility preservation at diagnosis was predictive (OR 2.78, 95% CI 1.29-6.00, P=0.009). History of infertility, nulliparity at diagnosis, tumor characteristics, cancer treatment, race, ethnicity, and BRCA1/2 PV status were not associated with either outcome. Conclusions: This is the first prospective study with greater than 10 years of follow-up to report fertility outcomes in young BC survivors accounting for attempting pregnancy. The majority achieved a pregnancy and most reported a live birth. Our findings can be incorporated into the counseling of young BC patients and survivors, and highlight the need for accessibility of fertility preservation services for this population. Clinical trial information: NCT01468246 .

Discontinuation of Gender-Affirming Medical Treatments: Prevalence and Associated Features in a Nonprobabilistic Sample of Transgender and Gender-Diverse Adolescents and Young Adults in Canada and the United States

PurposeThis study investigated the prevalence, correlates, and reasons for discontinuing gender-affirming medical treatment (GAMT) among transgender and gender-diverse adolescents and young adults living in Canada and the United States of America. MethodsThis exploratory study used data from an online survey of sexual and gender minority adolescents and young adults aged 15–29 years living in Canada or the United States of America (March–August 2022). The analytic sample was constituted by participants who responded to questions regarding starting and stopping GAMT, as well as reasons for stopping. Correlates of discontinuing GAMT were assessed using univariate logistic regression. ResultsThe mean age of the analytic sample (N = 3,937) was 21.1 years. Participants were predominantly nonbinary (54.2%) and assigned female at birth (80.8%). 75.5% lived in Canada and 24.5% in the United States of America. Among those who had started GAMT, 121 of 720 (16.8%) reported having ever discontinued treatment. Forty five of 121 (37.2%) who ceased GAMT reported “Yes, but I wish I hadn't.” The most frequently endorsed reasons for discontinuing GAMT were health reasons (37.3%), a change in gender identity (32.0%), and cost (16.0%). Greater age; nonbinary identity, ‘other’ gender identity; diagnosis of or self-identifying as living with schizophrenia; residing in the United States of America (relative to Canada); and endorsing a current Christian identity were associated with discontinuation. Ninety seven of 121 (80.2%) who discontinued GAMT reported a current transgender or gender-diverse identity. DiscussionGiven the dearth of information about the subpopulation who discontinue GAMT, this study advances candidate factors to inform future longitudinal research to better understand the multiple reasons and contexts for stopping GAMT.