Average Change Research Articles

Incidence Trends and Risk of Recurrent Stroke of Cervical Artery Dissections in the United States Between 2005 and 2019.

Cervical artery dissection (CeAD) is a common cause of acute ischemic stroke (AIS), especially in patients younger than 55 years, but data regarding trends and subsequent AIS risk after CeAD remain scarce. We aimed to determine national trends in CeAD admissions and examine post-CeAD risk of ischemic stroke. We used the National Inpatient Sample (2005-2019), National Readmission Database (2015-2019), and State Inpatient Database for New York (2011-2017) and Florida (2011-2019). Adult patients with spontaneous CeAD were identified using International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification codes. Survey-weighted annual CeAD cases were combined with US census data to estimate annual incidence. National estimates were verified with state-level data, which allows for the removal of duplicate admissions for a single patient through a unique patient identifier. Joinpoint regression was used to quantify the average annual percent change (AAPC) of CeAD incidence. AIS readmission risk after CeAD without concurrent AIS was assessed with death as a competing risk using Fine and Gray competing risk methodology. From 2005 to 2019, we identified 125,102 patients (46.09% female, mean age 51.4 years) with spontaneous CeAD. CeAD incidence increased from 10.7 cases per million population in 2005 to 45.6 cases per million population in 2019, revealing an AAPC of 10.21% (95% CI 9.67%-10.76%). This substantial increase in CeAD admissions was particularly high in the older, Black, and Hispanic populations. Statewide data corroborated this upward trend with an AAPC of 8.47% (95% CI 7.97%-9.48%). Among patients with CeAD without AIS, vertebral artery dissection was the sole major predictor of subsequent ischemic stroke risk within 90 days (adjusted subdistributed hazard ratio 1.77, 95% CI 1.18-2.64, p = 0.006). Interaction and subgroup analyses were performed and demonstrated similar results. There was an almost 5-fold increase in CeAD hospitalizations and an upward incidence trend from 2005 to 2019, particularly in racial minorities, which may be attributed to increased imaging and awareness of CeAD. Our study also revealed a small but significant risk of AIS in patients with vertebral artery dissection without concurrent ischemic stroke. These findings underscore the importance of studying acute treatment and secondary prevention strategies in patients with CeAD.

Global, regional, and national trends in peripheral arterial disease among older adults: findings from the global burden of disease study 2021

ImportanceLower extremity peripheral arterial disease (PAD) is a significant health concern among older adults globally, affecting both mortality and quality of life.ObjectiveTo evaluate the temporospatial trends and its risk factors in lower extremity PAD-related burden among adults aged 60 years and older from 1990 to 2021.Design, setting, and participantsThis repeated cross-sectional study utilized data from the Global Burden of Disease Study 2021, encompassing 204 countries and territories. The study population included adults aged 60 years and older.ExposureLower extremity PAD among older adults from January 1990 to December 2021.Main outcomes and measuresPrimary outcomes included age-standardized prevalence rates (ASPR), mortality rates (ASMR), disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs). Trends were analyzed by age, sex, and sociodemographic index (SDI). Joinpoint regression analysis was used to identify significant trend changes.ResultsFrom 1990 to 2021, global trends showed decreases in lower extremity PAD-related prevalence, mortality, and DALYs. Significant geographical disparities were observed: high-SDI regions had the highest prevalence (11,171.66 per 100,000 in 2021) but showed declining trends (AAPC, -0.74; 95% CI, -0.80 to -0.68), while low-SDI regions had the lowest prevalence (4,842.40 per 100,000) but demonstrated increasing trends (AAPC, 0.22; 95% CI, 0.21 to 0.24). Regionally, although lower extremity PAD-related prevalence showed a decreasing trend in most regions from 1990 to 2021, there were still some regions with an increasing trend (North Africa and Middle East AAPC, 0.57; 95% CI, 0.55 to 0.59). Temporal analysis showed sex-specific divergent trends in recent years, with males exhibiting an upward trend since 2015 (APC, 0.15; 95% CI, 0.07 to 0.24), while females showed a slowed decline since 2014 (APC, -0.06; 95% CI, -0.12 to -0.01). Decomposition analysis identified population growth as the primary driver of PAD burden increase, with epidemiological changes showing contrasting effects across SDI regions. Among risk factors, high fasting glucose emerged as the leading contributor, while smoking’s contribution decreased.Conclusions and relevanceThis study revealed significant disparities in lower extremity PAD burden across different SDI levels and regions, with low-SDI countries facing an increasing burden. The contrasting trends between high- and low-SDI regions, coupled with varying risk factor patterns (particularly the rise in high fasting glucose and decline in smoking), suggest the need for targeted interventions in resource-limited settings to address this growing health challenge among older adults.

The burden of ischemic heart disease among women of childbearing age in China from 1990 to 2021, and projections for the next 15 years

BackgroundThere are no studies on the burden of ischemic heart disease (IHD) among women of childbearing age (WCBA) in China. This study aims to describe the IHD burden among WCBA in China from 1990 to 2021, predict the trends over the next 15 years, and identify the contributing factors associated with IHD-related deaths.MethodsThe data was extracted from the Global Burden of Disease Database 2021. The Direct age-standardized method was used to estimate the age-standardized (AS) prevalence rate (ASPR), mortality rate (ASMR), incidence rate (ASIR), and disability-adjusted life years rate (ASDR) of IHD among WCBA. Joinpoint regression analysis was used to analyze the Annual Percent Change and Average Annual Percent Change from 1990 to 2021. The Autoregressive Integrated Moving Average model was used to predict the trend over the next 15 years.ResultsFrom 1990 to 2021, the ASPR and ASIR increased by 17.44% and 25.83%, culminating in 616.50 (95% UI, 498.42-762.38) and 79.93 (95% UI, 49.43–113.88) cases per 100,000 individuals. Conversely, the ASMR and ASDR declined to 5.17 (95% UI, 4.14–6.33) and 261.24 (95% UI, 212.03–318.03) cases per 100,000 individuals. Over the next 15 years, the ASPR is projected to increase by 25.74%, culminating in 775.20 (95% UI, 637.98–912.42) cases per 100,000 individuals. The main contributor to increased IHD-related deaths among WCBA in China was high low-density lipoprotein.ConclusionsDespite the significant decline in the ASMR and ASDR of IHD among WCBA in China over the last 30 years, the ASPR and ASIR continue to increase. Additionally, the ASPR is projected to rise over the next 15 years. These findings emphasize that effective measures and timely interventions are needed to reduce the disease burden.

Time trends in multiple myeloma incidence and mortality across the BRICS from 1992 to 2021 and projection to 2046

ObjectiveThis study evaluates the long-term trends in Multiple Myeloma (MM) incidence, mortality, and Age-Period-Cohort (APC) effects in the BRICS nations (Brazil, Russia, India, China, and South Africa).MethodsData on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and 95% uncertainty intervals (UIs), were obtained from the Global Burden of Disease Study 2021. Joinpoint regression model was used to estimate the average annual percentage change (AAPC) and annual percentage change (APC) trends from 1992 to 2021, and the Age-Period-Cohort model evaluated nonlinear impacts of age, period, and cohort effects. Projections to 2046 were calculated using Bayesian APC modeling.ResultsFrom 1992 to 2021, MM incidence and death cases in the BRICS nations increased nearly four to fivefold, with ASIR and ASMR nearly doubling. China and India had lower ASIR and ASMR than other BRICS countries despite accounting for over half of cases and deaths. South Africa consistently had the highest ASIR and ASMR in both 1992 and 2021. China experienced a significant increase in ASIR (AAPC 4.92%, p < 0.001) and ASMR (AAPC 4.07%, p < 0.001) over the past three decades. MM incidence and mortality increased with aging, and the age effect on MM was more pronounced among individuals aged greater than 40 years. Birth cohorts’ impact on MM varied greatly between BRICS, with China suffering the largest risk increase among those born after the 1970s. Projections indicate ASIR and ASMR will reach 2.44 and 1.82 per 100,000 by 2046, continuing to rise across the BRICS nations.ConclusionsMM burden is rapidly increasing in the BRICS, closely tied to population aging. Targeted strategies addressing each country’s unique challenges are essential as the burden continues to grow.

Application of the information-motivation-behavioral skills model to improve medication adherence among older adults with type 2 diabetes: findings from a quasi-experimental study in Kermanshah, Iran

IntroductionMedication adherence is crucial for effective blood sugar control in diabetes patients. However, older adults face a higher risk of non-adherence. This study aims to evaluate the effectiveness of a theory-based program designed to enhance medication adherence among older adults with type 2 diabetes.MethodsThis quasi-experimental study involved 100 elderly individuals with type 2 diabetes in Kermanshah, Iran, in 2024. Participants were randomly assigned to an intervention (50) or control group (50). The intervention group attended six 40-minute sessions over six weeks, based on the Information-Motivation-Behavioral Skills (IMB) model. Data were collected via a questionnaire assessing demographics, IMB model components, and medication adherence. Data were analyzed using SPSS version 16, employing chi-square tests and t-tests for comparisons, moreover, effect sizes were determined using Cohen’s d.ResultsThe intervention group showed significant improvements, especially in “Information,” with a very large effect size of 1.3 and an average change of 3.84 (p < 0.001). In contrast, the control group had minimal changes. Other components like “Attitude” and “Self-efficacy” also had large effect sizes (0.65 and 0.67). However, “Subjective Norms” showed a small effect size (0.11) with no significant changes. Additionally, the intervention group showed a significant improvement in medication adherence (effect size 1.15), increasing scores from 16.92 to 19.76, (p < 0.001) while the control group had minimal changes.ConclusionThe program based on the IMB model significantly improved medication adherence among elderly individuals with type 2 diabetes. We also identified the key theoretical methods of behavior change for each determinant of the IMB model and recommend utilizing them in the development of similar future interventions.

Mortality Trends in Preterm Infants with Birth Weight Less Than 500 Grams in the United States.

This study aimed to determine the temporal trends and racial differences in the infant mortality rate (IMR) in preterm infants with birth weight <500 g in the United States from 2005 through 2022.This was a retrospective cross-sectional study of data from the CDC's Wide-ranging Online Data for Epidemiologic Research. Infants with gestational age (GA) 22 to 28 weeks, with birth weight of <500 g, and deaths up to 1 year of age were included. IMR was calculated as deaths per 1,000 live births for each GA and year, and further stratified by maternal race. We evaluated trends with Joinpoint regression and IMR trends were reported using average annual percentage change (AAPC) with 95% confidence intervals (CI). The fetuses-at-risk approach was used to examine racial/ethnic differences in IMR.During the study period, 39,511 out of 50,855 infants born at 22 to 28 weeks GA with birth weight <500 g died within the first year (overall IMR 776.93 per 1,000). The IMR was inversely related to gestational age. The overall IMR decreased significantly from 817.48 to 714.51 (AAPC of -0.8%; CI, -1.0, -0.6) and in all the three racial/ethnic groups. As per the fetuses-at-risk approach, non-Hispanic Black (NHB) infants had the highest IMR of 1.33 per 1,000 fetuses-at-risk compared with 0.39 for non-Hispanic White (NHW) and 0.46 for Hispanic infants (p < 0.01).The IMR in extremely preterm infants weighing <500 g at birth decreased significantly, overall, and in all racial/ethnic groups. However, significant racial/ethnic differences persist. · Infant mortality rate decreased significantly in preterm infants with birth weight <500 g.. · The IMR decreased significantly in the three racial/ethnic groups studied.. · The IMR was significantly higher in non-Hispanic Black infants..

Epidemic Trends and Spatial Distribution Characteristics of Hepatitis B in China: Surveillance Study.

Hepatitis B is an important public health challenge facing China. Understanding the long-term epidemiological trends and evolving spatial distribution patterns is critical for optimizing prevention strategies and achieving the World Health Organization's 2030 hepatitis elimination targets. This study aimed to explore the epidemic trends and spatial distribution characteristics of hepatitis B in China from 2004 to 2020. This study used data on hepatitis B incidence from 2004 to 2020 from the China Public Health Science Data Center to analyze the time trend of hepatitis B incidence by joinpoint regression. The age-period-cohort model was used to analyze the age, period, and cohort effects of hepatitis B onset. Spatial autocorrelation analysis was used to explore the spatial distribution characteristics of hepatitis B in China. From 2004 to 2020, China reported a total of 17,449,842 cases of hepatitis B, with an average annual incidence rate of 76.30/100,000. The incidence of hepatitis B in China showed an increasing trend from 2004 to 2007, with an average annual percentage change (AAPC) of 9.49 (95% CI 2.12-17.39), and a decreasing trend from 2007 to 2014, with an AAPC of -3.77 (95% CI -5.93 to -1.55). The incidence of hepatitis B in China tended to be stable from 2014 to 2020, with an AAPC of -0.46 (95% CI -2.86 to 2.01). Age, period, and cohort effect significantly affect the incidence of hepatitis B. The age effect showed that the incidence rate of hepatitis B reached its peak at the age of 22 years, with an average incidence rate of 176.173/100,000. The period effect showed that the highest level during the study period occurred during 2004-2006. The cohort effect showed that the risk of hepatitis B increased first and then decreased, with the turning point of 1924-1974. The incidence of hepatitis B varies significantly among regions. The incidence in the northeast and northwest regions has decreased, that in the south and southwest regions has increased, and that in other regions has remained stable. China has achieved remarkable results in the prevention and control of hepatitis B, but there are still differences in the incidence rate among different age groups and regions. These results suggest the need to further strengthen the identification and screening of high-risk populations and promote supplementary adult hepatitis B vaccination. Future intervention strategies should fully consider regional differences, implement precise intervention measures based on the epidemic trends and spatial distribution characteristics of each region, optimize resource allocation, and enhance the overall effectiveness of hepatitis B prevention and control.

Global, region and country burden of osteoarthritis at different sites in middle-aged and elderly populations from 1990 to 2021: a systematic analysis of the 2021 global burden of disease study

ObjectiveTo explore the burden and trend of osteoarthritis (OA) at different sites in middle-aged and elderly people (45 years and older) from 1990 to 2021.MethodsAge-standardized incidence rates, prevalence rates, disability-adjusted life years (Daly) rates and average annual percent change were used to quantify the disease burden and trend of OA at different sites. Decomposition analysis was conducted to explore the impact of three population-level determinants on the burden of OA and the distribution of OA burden inequality in the Socio-Demographic Index (SDI) across countries.ResultsThe age-standardized prevalence rate had increased by 8.9%, and the OA cases had increased by 2.41 times compared to 1990. The incidence and prevalence of knee, hip and hand OA decreased sequentially, while high SDI regions tended to have higher age-standardized incidence rates, prevalence rates, and Daly rates. Decomposition analysis revealed that 85.9% of the increase in OA age-standardized Daly rates was attributable to population growth. This increase was most pronounced in high SDI populations for hip OA and middle SDI populations for knee and hand OA. From 1990 to 2021, the inequality in overall OA burden between countries had decreased. The absolute inequality gap for hand OA had narrowed the most significantly (45.3%), which followed by knee OA (11.9%), while the inequality gap for hip OA has slightly increased.ConclusionIn summary, all parts of the OA burden in middle-aged and elderly people had steadily increased from 1990 to 2021, which calls to implement personalized prevention targeting different parts of OA.

Trends and projections of the burden of gastric cancer in China and G20 countries: a comparative study based on the global burden of disease database 2021.

Trends and projections of the burden of gastric cancer in China and G20 countries: a comparative study based on the global burden of disease database 2021.

Evolving global trends in PCOS burden: a three-decade analysis (1990–2021) with projections to 2036 among adolescents and young adults

BackgroundPolycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting adolescent and young adult females, yet global data on its burden and trends remains limited.MethodsWe analyzed data from the Global Burden of Disease Study 2021 for females aged 10–24 years in 204 countries (1990-2021). Metrics included cases, age-standardized incidence (ASIR), prevalence (ASPR), disability-adjusted life years (ASDR), and average annual percentage changes (AAPCs). Future trends (2022-2036) and disease reduction gaps were assessed.ResultsFrom 1990 to 2021, global PCOS cases increased by 56% (incidence), 59% (prevalence), and 58% (DALYs). ASIR rose from 49.45 to 63.26 per 100,000, with an AAPC of 0.8. Southeast Asia, East Asia, and Oceania had the fastest growth, while high-SDI regions bore the highest burden. Girls aged 10–14 showed the steepest age-specific increase. Nationally, the largest increases occurred in Equatorial Guinea, Maldives, and Myanmar, while Italy saw a decline. Forecasts through 2036 indicate continued increases in ASIR (+8.32%), ASPR (+10.87%), and ASDR (+10.39%). Frontier analysis highlighted unachieved reduction potential, especially in high-SDI countries.ConclusionsPCOS burden among adolescents and young adults has significantly risen globally with disparities by region, SDI, and age, warranting urgent and equitable public health strategies.

Epidemic characteristics and effectiveness of vaccine intervention on rotavirus infection: a real-world observational study in Zhejiang Province, China

BackgroundRotavirus infection, the most common cause of infant infectious diarrhoea and related deaths worldwide, has imposed a high disease burden in China, especially in Zhejiang Province. This study described the overall epidemiological characteristics and trends of reported rotavirus infections in Zhejiang Province from 2005 to 2022 and evaluated the effectiveness of rotavirus vaccines on the incidence of rotavirus infection.Materials and methodsData on reported cases of rotavirus infection from 2005 to 2022 were extracted from the China Disease Prevention and Control Information System. Information on rotavirus vaccination was obtained from the Zhejiang Provincial Viral Diarrhoea Surveillance Site in 2022. Join-point regression, spatial and temporal aggregation analysis, and an age-period-cohort model were used to explore the epidemiological trends of rotavirus infection. Interrupted time series analysis and an overdispersed Poisson model were used to quantify the effectiveness of rotavirus vaccines.ResultsThe average age-standardized reporting incidence rate (ASRIR) of rotavirus infection in Zhejiang Province was 38.58/100,000, particularly in children aged 0–2 years, who had the highest average annual incidence of 951.63/100,000. The annual ASRIR of all ages showed a significant upward trend before 2017 (average percentage change [APC] = 21.64%) and then decreased significantly (APC = −23.02%). However, in children aged 6–19 years, the annual incidence presented a sustained and significant upward trend over time. The rotavirus infection peak showed a seasonal drift in Zhejiang Province, shifting from November before 2014 to January after 2014. Spatiotemporal aggregation revealed two clusters. The spatio-temporal scanning found two spatio-temporal aggregation areas, the first level spatio-temporal aggregation area was distributed in Hangzhou, Jiaxing and Huzhou, and the second level spatio-temporal aggregation area was Lishui. The age-period-cohort model indicated that the risk of rotavirus infection was primarily concentrated in children aged 0–4 years. The vaccine effectiveness (VE) of rotavirus vaccines was 71.62% (95% confidence interval [CI]: 45.21–86.05%) in children aged 2–59 months, in which the VE of the human-bovine reassortant pentavalent vaccine (RV5) was 91.31% (95% CI: 74.39–97.97%). Since the implementation of RV5 vaccination in September 2018, the number of cases of rotavirus infection per month has decreased by 3,061 (65.27%) in Zhejiang Province.ConclusionThe disease burden of rotavirus infection in Zhejiang Province was high, especially in children. Rotavirus vaccination have significantly reduced the incidence rate of rotavirus infection. Therefore, the prevention of infectious diarrhoea should be further strengthened, especially through increased coverage with the rotavirus vaccine.

Burdens of idiopathic developmental intellectual disability attributable to lead exposure from 1990 to 2021 and projection to 2035 in China: findings from the 2021 global burden of disease study

ObjectiveTo analyze the burden and trend of idiopathic developmental intellectual disability (IDII) attributed to lead (Pb) exposure in China from 1990 to 2021 and to predict the trend from 2022 to 2035.MethodWe used the Global Burden of Disease Study (GBD) 2021 data to estimate disability-adjusted life years (DALYs) and age-standardized DALY rate (ASDR) of IDII attributable to Pb exposure. The annual average percentage change (AAPCs) was estimated to evaluate the changing trend of IDII ASDR attributable to Pb exposure from 1990 to 2021. The age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) was used to assess and predict changes in the DALYs of IDII attributable to Pb exposure.ResultFrom 1990 to 2021, the number of DALYs and rate of the total population, males and females in China showed a fluctuating and decreasing trend. The APC showed that the age deviation had an upward trend and then decreased, the period deviation showed an ‘N’ shaped trend, and the cohort deviation model showed a trend of first increasing and then decreasing. The BAPC model predicts that the number of DALYs and ASDR will continue to decline, with males declining faster than females, and that by 2035, females will have higher DALYs and ASDR than males.ConclusionFrom 1990 to 2035, the burden of IDII attributed to Pb exposure in China showed a downward trend. But the DALYs and ASDR in females will be higher than that in males in 2035. It is essential to prioritize intervention, prevention, and control measures for females.

A mechanism of global gene expression regulation is disrupted by multiple disease states and drug treatments.

Conventional expression studies quantify messenger RNA (mRNA) transcript levels gene-by-gene. We recently showed that protein expression is modulated at a global scale by amino acid availability, suggesting that mRNA expression levels might be equivalently affected. Through re-analysis of public transcriptomic datasets, it was confirmed that nucleobase supply interacts with the specific demands of mRNA A + U:C + G sequence composition to shape a global profile of expression, which can be quantified as a gradient of average expression change by average composition change. In mammals, each separate organ and cell-type displays a distinct baseline profile of global expression. These profiles can shift dynamically across the circadian day and the menstrual cycle. They are also significantly distorted by viral infection, multiple complex genetic disorders (including Alzheimer's disease, schizophrenia, and autoimmune disorders), and after treatment with 115 of the 597 chemical entities analysed. These included known toxins and nucleobase analogues, but also many commonly prescribed medications such as antibiotics and proton pump inhibitors, thus revealing a new mechanism of drug action and side-effect. As well as key roles in disease susceptibility, mRNAs with extreme compositions are significantly over-represented in gene ontologies such as transcription and cell division, making these processes particularly sensitive to swings in global expression. This may permit efficient, en bloc transcriptional reprogramming of cell state through simple adjustment of nucleobase proportion and supply. It is also proposed that this mechanism helped mitigate the loss of essential amino acid synthesis in higher organisms. In summary, global expression regulation is invisible to conventional transcriptomic analysis, but its measurement allows a useful distinction between active, promoter-mediated gene expression changes and passive, cell state-dependent transcriptional competence. Linking cell metabolism directly to gene expression offers an entirely new perspective on evolution, disease aetiopathology (including gene x environment - GxE - interactions), and the nature of the pharmacological response.

Optimizing efficiency in Tanzanian public hospitals through improved productivity and resource utilization

Efficient healthcare delivery is crucial for achieving optimal health outcomes, particularly in developing countries facing resource allocation challenges. This study evaluates regional healthcare efficiency in Tanzania using Data Envelopment Analysis (DEA) with data from 2017 to 2021, employing both Constant Returns to Scale (CRS) and Variable Returns to Scale (VRS) methods and analyzing productivity trends through the Malmquist Productivity Index (MPI). The results indicate an average scale efficiency of 56.8%, with Dar es Salaam, Morogoro, Kilimanjaro, Arusha, and Tanga achieving full efficiency, while Ruvuma (26.7%) and Mtwara (28%) were the least efficient, highlighting significant regional disparities. CRS technical efficiency averaged 48.5%, implying a 51.5% input savings potential, while VRS technical efficiency averaged 82.3%, suggesting a 17.7% input savings potential. Additionally, only 19.23% of regions were efficient under CRS, and 30.77% under VRS. The MPI results showed that low technical change, with an average of 0.822, was a key driver of inefficiency despite a 2.063 average pure efficiency change, indicating poor technological progress. Further analysis of returns to scale found that 69.24% of regions operated under Increasing Returns to Scale (IRS), suggesting underutilization of resources, while 11.53% experienced Decreasing Returns to Scale (DRS), signaling inefficiencies from overextension. Recommendations to address these inefficiencies include targeted resource redistribution, improving healthcare worker conditions, staff capacity building, health information system integration, performance-based incentives, and fostering public–private partnerships to enhance service delivery and efficiency. Additionally, evidence-based decision-making frameworks and strong performance monitoring systems should guide reforms, promoting a more equitable and efficient healthcare system in Tanzania and many other developing countries.

The example of BTJE flow path contamination assessment with anti-icing fluid using statistical models

Contamination of the compressor flow path is one of the most prevalent issues encountered during the operation of aircraft gas turbine engines (GTEs). During operation in winter, ingestion of anti-icing fluids and de-icing agents into the compressor flow path presents a substantial risk. In particular, contamination of the compressor rotor blades leads to the reduction in the cross-sectional areas of the inter-blade channels, changes in their shape, and an increase in the roughness of the blade surfaces. All these phenomena compromise compressor performance: result in reduced efficiency, decreased pressure ratio, and airflow, resulting in lower engine thrust, increased jet pipe temperature, higher fuel consumption, reduced gas-dynamic stability, and altered rotor speeds. To eliminate contamination in the gas-air duct during operation, periodic washings of the flow part are performed using solid cleaners, liquid detergents, and water as cleaning agents. The article analyzes changes in deviations of bypass turbo-jet engine recorded parameters from baseline values both when contaminated with anti-icing fluids and after removing contaminants using statistical models based on time series analysis methods, dynamics of model characteristics describing relationships between parameters, as well as synchronization analysis of parameter changes in engines of the same aircraft. The article does not aim to report average parameter change values for a specific engine type and fault but rather demonstrates the principle and effectiveness of the diagnostic method that uses the principle of assessing the dynamics of significance and stability of correlation links between recorded parameters, which are currently underutilized in the scientific-methodological foundations of constructing and applying statistical diagnostic models in operational practice.

Comparative Perioperative Inflammatory and Functional Outcomes in Single Versus Multiple Joint Replacements for Hemophilic Arthritis: A Pilot Study.

Hemophilic arthritis is a progressive joint disease often requiring surgical intervention in advanced stages. However, comparative evidence on perioperative inflammatory and coagulation responses between single joint replacement (SJR) and multiple joint replacement (MJR) remains scarce. This study aimed to assess the differences in perioperative outcomes, including inflammatory responses, blood transfusion requirements, and functional recovery, to guide surgical decision-making for hemophilic arthritis patients. This retrospective study included 29 male patients with moderate-to-severe hemophilic arthritis who underwent SJR (n = 12) or MJR (n = 17) at a single institution from October 2020 to October 2023. Data on inflammatory markers (CRP, ESR, IL-6, WBC), hemoglobin levels, blood transfusion requirements, and joint mobility were collected for the immediate postoperative period (days 1-14). Trends in inflammatory markers were analyzed using average percent changes (APC), and differences in outcomes were evaluated using the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables. Longitudinal changes were analyzed using mixed-model repeated measures ANOVA with time points as fixed effects and subjects as random effects. Statistical significance was set at p < 0.05. Postoperative CRP levels declined significantly in both groups, with APCs of -9.06% (95% CI: -15.63 to -1.98, p < 0.05) for the SJR group and -8.42% (95% CI: -16.18 to 0.06) for the MJR group. ESR showed a significant upward trend, with APCs of 10.82% (95% CI: 0.95-21.65, p < 0.05) in the SJR group and 17.54% (95% CI: 11.71-23.67, p < 0.05) in the MJR group. Blood transfusion requirements were comparable, with median transfusion volumes of 0.00 units (IQR: 3.50) for SJR and 0.00 units (IQR: 3.75) for MJR (p = 0.761). Notably, joint mobility scores were significantly better in the MJR group (mean: 31.88, SD: 19.31) compared to the SJR group (mean: 18.33, SD: 10.39; p = 0.030). Despite the larger surgical scope of MJR, no significant differences in infection or bleeding risks (SJR:median transfusion = 0.00 units, IQR: 3.50; MJR:median transfusion, 0.00 units, IQR: 3.75. p = 0.761) were observed between the groups. This study demonstrates that MJR offers superior functional recovery compared to SJR, without increasing the risks of infection, bleeding, or transfusion. These findings support MJR as a safe and effective surgical option for hemophilic arthritis patients when appropriate perioperative management protocols are implemented. Future studies with larger sample sizes and long-term follow-up are needed to validate these results and explore extended outcomes.

Global, regional, and national burden of cardiovascular diseases attributable to metabolic risks across all age groups from 1990 to 2021: an analysis of the 2021 global burden of disease study data

ObjectiveThe objective is to evaluate the temporal trends in the burden of cardiovascular diseases attributable to metabolic risk factors from 1990 to 2021 and to project the burden over the subsequent 30 years.MethodsA joinpoint regression model was employed to estimate the annual percentage change in cardiovascular disease mortality attributable to metabolic risk factors, utilizing data from the Global Burden of Disease (GBD) 2021. An age-period-cohort analysis was conducted to evaluate the effects of age, period, and cohort. A frontier analysis was employed to investigate the correlation between the prevalence of cardiovascular disease attributable to metabolic risk factors and socio-demographic trends. An autoregressive integrated moving average (ARIMA) model was subsequently constructed to forecast future cardiovascular disease burden.ResultsBetween 1990 and 2021, the global age-standardized mortality rate (ASMR) of cardiovascular diseases attributable to metabolic factors exhibited a consistent decline (Average Annual Percent Change (AAPC) = -1.28, 95% CI [-1.42, -1.14], P < 0.01). However, the absolute number of deaths increased from 8.326 million to 13.595 million. The most substantial reduction in ASMR was observed in the High Socio-Demographic Index (SDI) region (AAPC = -2.98, 95% CI [-3.10, -2.86], P < 0.01), whereas the reductions were relatively smaller in the Low-middle SDI and Low SDI regions. The ARIMA model predicts a decline in global cardiovascular disease mortality over the next three decades, with the most pronounced decrease anticipated in the high-middle SDI region and smaller declines expected in the middle SDI and low SDI regions.ConclusionNotwithstanding a global decline in age-standardized mortality and disability-adjusted life year (DALY) rates, the burden of cardiovascular diseases attributable to metabolic factors remains significant worldwide. Targeted interventions must be implemented without delay, particularly for males and populations in low and middle SDI regions, to mitigate the impact of metabolic factors on public health.

Inflation-Adjusted Changes in Medicare Reimbursements for Commonly Performed Oculoplastics Procedures Over the Last Decade.

This study examines the inflation-adjusted changes in Medicare reimbursements for the most commonly performed oculoplastic procedures performed in the clinic and in the operating room from 2014 to 2023. The 2021 Medicare National Summary Data File was used to identify the 15 most often performed oculoplastics office procedures and operating room procedures in Medicare Part B beneficiaries by Current Procedural Terminology (CPT) code. The yearly reimbursements for each of these 30 CPT codes over the last decade were found using the Medicare Physician Fee Schedule Online Tool available on CMS.gov. Adjustments for inflation were made using the Consumer Price Index from the United States Bureau of Labor Statistics. Descriptive statistics were computed to show the change in reimbursement amount over time. Spearman rank correlation coefficients between the inflation-adjusted reimbursement amount and year were used to evaluate the trend over time for each procedure. The average nominal change in payment amount was -3.5% (range: -63.6% to 12.5%) for office CPT codes and -7.7% (range: -35.3% to 6.5%) for facility CPT codes. The average inflation-adjusted change in payment amount was -24.6% (range: -71.5% to -12.1%) for office codes and -27.8% (range: -49.4% to -16.8%) for facility codes. There was a statistically significant negative correlation between inflation-adjusted reimbursement level and year of assessment for 29 of 30 CPT codes tested. Medicare inflation-adjusted reimbursements for the most commonly performed oculoplastic procedures have significantly decreased over the last decade with an average decline of 24.6% for office procedures and 27.8% for operating room procedures.

The Placebo Effect in Chronic Thromboembolic Pulmonary Hypertension Trials: A Systematic Review and Meta-Analysis

Introduction: Placebo-controlled studies are crucial in clinical trials, but the placebo effect can vary across conditions. We aimed to assess the placebo effect in chronic thromboembolic pulmonary hypertension (CTEPH) trials. Methods: We conducted a systematic review and included randomized placebo-controlled trials investigating CTEPH interventions. Primary outcomes were the pre–post changes in the 6 min walk test (6MWT) and quality of life in the placebo arms. Secondary outcomes included mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index, and NT-proBNP levels. Meta-analyses were performed using random-effects models. Results: Seven trials with 270 CTEPH patients in placebo arms were analyzed. The average 6MWT change was not significant (−1.31 m; 95%CI −12.49 to +9.79). Quality of life with EQ-5D was not significantly improved (−0.04; 95%CI −0.10 to +0.02). mPAP, PVR, cardiac index, and NT-proBNP also demonstrated non-significant changes with small magnitudes. Conclusions: The placebo effect in CTEPH trials was not statistically significant and had small magnitude but should not discourage the use of placebo-controlled trials where applicable and ethical.

Moving Sounds Increase Postural Visual Dependence in Adults With Chronic Traumatic Brain Injury.

This cross-sectional study aimed to (1) establish the safety and tolerability of head-mounted display (HMD) assessment of sensory integration for postural control in participants with chronic traumatic brain injury (TBI); (2) investigate whether responses to visual and auditory cues differ between persons with TBI and healthy controls; and (3) evaluate the relationship between postural responses, postural visual dependence, and self-reported perception of disability. 20 healthy adults and 19 participants with TBI completed an HMD assessment of with visual and auditory perturbations. Head sway was quantified as a directional path in the anteroposterior and mediolateral directions. Participants also completed the Simulator Sickness Questionnaire (SSQ) and the Dizziness Handicap Inventory (DHI). All participants completed testing. The average change in SSQ scores from pre to post postural control assessment was 0.8 points for healthy controls and 3.2 points for participants with TBI. Head sway in the TBI group was consistently higher in both directions, especially with dynamic visuals. In addition, a significant sound by visual by group interaction in the mediolateral direction indicates that participants with TBI responded more to the visual perturbations when sounds were present. Under the most challenging conditions, people with mild-to-moderate dizziness handicap showed little head sway, while those with severe symptoms were more variable. HMD assessment of participants with TBI is feasible and provides a clinic-based assessment of postural visual dependence in this population. This assessment carries the potential to evaluate postural control and monitor progress of participants with TBI.